What You Need To Know About High Blood Pressure

An estimated 1 in 3 American adults has high blood pressure (hypertension), with most sufferers in their late thirties or older. Approximately 46% of adults with high blood pressure aren't aware they have the condition: 42% of adults with high blood pressure receive a diagnosis and treatment. Many are undiagnosed or do not manage their condition properly, so they develop other health issues.

Researchers have worked extensively to discover ways to treat and manage high blood pressure, and most people can control it with some effort. Screening is vital, as high blood pressure has no symptoms until it’s done a lot of damage to the person's organs.

What is high blood pressure?

Your blood pressure is the force of your blood that pushes against your blood vessel walls. When this becomes too high consistently, it's referred to as high blood pressure (HBP). Another term is hypertension.

High blood pressure is a huge health issue that's more common in older individuals, although young adults and even teenagers can have elevated blood pressure. The blood vessel network in your body (vascular system) changes as you get older. Your arteries stiffen, causing your blood pressure to rise. This can occur even if you feel great and engage in heart-healthy activities and habits.

Also called "the silent killer," high blood pressure frequently doesn't cause any warning signs. While hypertension affects almost half of all adults, many aren't aware they have it.

Depending on your activities, your blood pressure changes during the day. When your blood pressure measurements are consistently above 120/80 mm Hg, you may be diagnosed with hypertension.

High blood pressure can be dangerous, and the higher it becomes, the greater risk you have for other types of health issues, such as:

  • Stroke

  • Heart attack

  • Heart disease

Statistics

Around one in three (over 100 million) individuals in the U.S.¹ have high blood pressure. However, only half of them are managing their condition. 

Men have a greater risk of getting high blood pressure than women² until they reach the age of 64 years old. When women turn 65, they have a greater risk.

In the U.S., African-Americans tend to have hypertension² more frequently than people from other racial backgrounds.

  1. High blood pressure–Understanding the silent killer | U.S. Food & Drug Administration

  2. Know your risk factors for high blood pressure | Heart Attack and Stroke Symptoms

Symptoms

Hypertension generally doesn't produce any symptoms or warning signs at first, which is why it's frequently referred to as the silent killer. Since you may not experience any symptoms, you may have high blood pressure and not even know it.

Early detection of high blood pressure is important since it can raise your risk for certain diseases. If your blood pressure becomes too high, you may experience the following symptoms:

  • Shortness of breath

  • Headaches

  • Dizziness

  • Chest pain

  • Nosebleeds

  • Visual problems

It's essential to know about your hypertension and the associated health risks it can pose before it is at the stage where it's producing symptoms. The only way you'll know for certain if you have high blood pressure is by getting your blood pressure measured. Then, you can work closely with your healthcare provider to determine appropriate treatment options to keep your blood pressure at healthy levels. Understanding What Is Renal Hypertension

Complications

According to the American Heart Association¹, a hypertensive crisis is when your blood pressure increases rapidly with readings of 180/120 mmHg or higher.

There are consequences of uncontrolled high blood pressure that can be serious, including:

  • Shortness of breath

  • Severe headache

  • Severe anxiety

  • Nosebleeds

High blood pressure can cause serious heart damage. Excessive pressure can cause your arteries to harden, reducing the flow of oxygen and blood to your heart. The reduced flow of blood and elevated pressure can lead to:

  • Angina (chest pain)

  • A heart attack, which occurs when the supply of blood to your heart becomes blocked, and your heart muscle cells die due to a lack of oxygen. The longer the flow of blood is blocked, the greater the heart damage

  • An irregular heartbeat that can cause sudden death

  • Heart failure, which occurs when your heart can't pump enough oxygen and blood to other crucial body organs

Hypertension can block or burst the arteries that supply oxygen and blood to your brain, leading to stroke. It can also cause damage to your kidneys, which can lead to kidney failure.

Causes

Research shows that environmental and genetic factors¹ may cause essential hypertension (high blood pressure not due to an underlying medical condition). Some environmental factors include:

  • Obesity

  • Chronic stress

  • Salt intake

  • Alcohol intake

  • Physical inactivity

Some causes of high blood pressure include:

1. Lack of physical activity

Less fit and less active individuals have a higher chance of developing hypertension. Research² shows that physically active people have less of a risk of developing coronary heart disease than those who aren't physically active. This is true even after accounting for alcohol use, smoking, and diet.

2. Job strain

There's a link between work stress and coronary heart disease. Numerous studies¹ have shown job strain is linked with higher ambulatory blood pressures in men. Lifestyle and environmental factors likely operate interchangeably instead of on their own to contribute to hypertension.

3. Being overweight

High blood pressure can result from being overweight or obese. Obesity can lead to other severe health problems that can be potentially life-threatening, including:

  • Increased unexplained heart failure

  • Increased risk of coronary disease

An inactive lifestyle and psychological factors like low self-esteem, depression, and lack of sleep can contribute to weight gain³ immensely.

4. Using tobacco

Chewing and smoking tobacco not only temporarily raises your blood pressure, but the chemicals found in tobacco can damage the lining of your artery walls. Your arteries can begin narrowing and raise your heart disease risk, which also increases with secondhand smoke exposure.

5. Too much sodium (salt) in your diet

An excess of dietary sodium can lead to your body retaining fluid, increasing your blood pressure.  Even if you don’t add salt to your food, if you are eating restaurant food, frozen dinners, or processed foods, the chances are that you are getting more sodium in your diet than you need.

6. Not enough potassium in your diet

A sufficient balance of potassium is essential for heart health. Potassium balances how much sodium you have in your cells. Sodium can accumulate in your blood if you're not getting enough potassium, losing too much of it through dehydration, or because of a health condition.

7. Too much alcohol consumption

Heavy drinking can cause heart damage over time. If you must drink alcohol, you should drink it in moderation. Drinking more than one alcoholic beverage a day for women and more than two a day for men can affect your blood pressure.  A single drink equals 5oz of wine, 12oz of beer, or 1.5oz of 80-proof liquor.

8. Stress

High stress levels can cause a temporary blood pressure increase. Stress-related habits can further increase blood pressure. These may include:

  • Using tobacco

  • Eating more than your body needs

  • Drinking alcohol

9. Certain chronic disorders

Some chronic disorders may raise your risk of hypertension, including:

  • Thyroid problems

  • Kidney disease

  • Metabolic syndrome

  • Diabetes

  • Sleep apnea

In some cases, pregnancy can contribute to high blood pressure.

Risk factors

Certain individuals have an increased risk of high blood pressure due to risk factors they cannot control. These may include:

  • Gender: Men have a higher risk of high blood pressure⁴ before turning 55. After menopause, women have a higher risk of high blood pressure.

  • Age: The likelihood of getting hypertension increases as you age⁴.

  • Race: African-Americans have a higher risk for hypertension.

  • Family history: Hypertension can run in families.

How is high blood pressure diagnosed?

Having your blood pressure measured by your doctor is the ideal way to diagnose hypertension.

Your doctor will record two numbers when measuring your blood pressure reading. These are:

  • The top number (systolic blood pressure): This shows the amount of pressure your blood exerts against the walls of your arteries while the heart is beating.

  • The bottom number (diastolic blood pressure): This shows the amount of pressure your blood exerts against the walls of your arteries while your heart rests between beats.

Your doctor will perform a physical exam and ask about your medical history. They will measure your blood pressure by placing an inflatable, appropriate-sized arm cuff around your arm with an attached pressure-measuring gauge.

Both numbers are significant in your reading. However, systolic reading is even more important after 50, where there's a greater chance for isolated systolic hypertension⁵. This is a condition where you have a normal diastolic pressure (the bottom number is less than 80 mm Hg), but your systolic pressure is high (the top number is equal to or greater than 130 mm Hg).

Your blood pressure varies throughout the day and can increase during a visit to your doctor, called “white coat hypertension.” Your doctor will require several blood pressure readings before diagnosing you with hypertension.

They may request that you take your blood pressure measurements at home and record them. This will give your doctor additional information and confirm whether or not you have hypertension. Home monitoring is an essential way to:

  • Confirm the occurrence of hypertension

  • Check the success of blood pressure treatments

  • Diagnose worsening of hypertension

How often should you get your blood pressure checked?

If you have higher than normal blood pressure, your doctor will give you instructions on how frequently you should check your blood pressure measurements at home. They'll also tell you what you should do if you have elevated readings.

It's still important for you to have your regular blood pressure checks even if you don't have hypertension since blood pressure can change over time:

  • Individuals between 18 and 39 who aren't at risk for hypertension should get their blood pressure checked every three to five years.

  • Individuals 40 or older, or those with a higher risk for hypertension, should get their blood pressure checked annually.

You may need your blood pressure checked more often if you:

  • Have diabetes, heart disease, or kidney disease

  • Have a family history of high blood pressure

  • Smoke

  • Have insomnia or sleep apnea

  • Are obese or overweight

  • Have any of the symptoms listed above

Your doctor's office isn't the only place you can have your blood pressure checked. You can set up an appointment at your favorite pharmacy. Certain healthcare clinics will provide a free blood pressure check. You can also test your blood pressure at home using a blood pressure monitor, although these are not always as accurate as medical equipment.

Treatments

Treatments for high blood pressure typically include lifestyle changes, medication, a treatment plan, or a combination.

Lifestyle changes

Living a healthy lifestyle is your first line of defense against hypertension. Some habits to incorporate into your daily routine to manage your blood pressure include:

  • Maintaining a healthy weight

  • Eating a healthy diet

  • Managing your stress levels

  • Staying physically active

  • Eating less salt

  • Quitting smoking and avoiding secondhand smoke

  • Limiting caffeine

  • Avoiding excessive alcohol consumption

  • Monitoring your blood pressure

  • Obtaining support from friends and family

Ongoing medical care

You will need routine medical checkups and blood pressure reviews. Regular checkups will let your doctor see if your treatment is working and make any adjustments if necessary.

If your doctor notices your blood pressure is rising again, they'll respond promptly. Visiting your doctor also means you can bring up any concerns and ask questions.

Treatment for specific situations

You may require additional treatment options in certain situations. A good example is if you have either resistant or secondary hypertension.

Resistant hypertension is where your blood pressure stays high after you've attempted a minimum of three different blood pressure medication types. So, if you're taking three different types of medication for high blood pressure, you're considered to have resistant hypertension.

Secondary hypertension is where your high blood pressure results from another health condition or drug side effect. Blood pressure frequently lowers significantly or returns to normal once a doctor starts treating the root cause.

Can high blood pressure be reversed or cured?

There are two primary types of high blood pressure. These are "essential" (primary) hypertension and secondary hypertension. 

Primary hypertension

There isn't a cure yet for primary high blood pressure. Most people with hypertension have "primary" hypertension, which is the type of high blood pressure that doesn’t result from medication side effects or an underlying medical condition.

You can keep your high blood pressure under control by choosing healthy lifestyle habits, but you'll likely require medication eventually to maintain safe blood pressure levels.

Generally, once you develop primary hypertension, you always have it. Primary hypertension can result in severe complications later on in life without treatment, such as kidney and heart disease. Scientists are still trying to understand why some individuals develop primary hypertension.

Secondary hypertension

Another health condition or medication causes secondary hypertension. So, if your doctor treats the underlying condition or changes your prescription, it could lower blood pressure. However, some people will still require blood pressure medication to normalize their blood pressure.

How can you measure your blood pressure?

There are several ways to measure your blood pressure. These include:

  • Your doctor will measure your blood pressure at their office

  • You can use a digital blood pressure measurement device at your local pharmacy

  • You can measure your blood pressure with a home blood pressure monitor that you can buy at your local drug store without a prescription.

Medication

Several blood pressure medications (antihypertensives) lower high blood pressure. They are available only by prescription and come in various classes.

Different classes of medication for high blood pressure include:

1. Diuretics

Diuretics help your body eliminate excess salt (sodium) and water, keeping blood pressure under control: They're frequently used with other prescription therapies.

Major types of diuretics include:

  • Thiazide diuretics (Microzide, chlorthalidone, Diuril)

  • Loop diuretics (furosemide, bumetanide)

  • Potassium-sparing diuretics (Aldactone, amiloride, Dyrenium)

  • Combination diuretics (these include more than a single type used together)

Some diuretics can reduce the potassium supply in your body. You may experience side effects such as leg cramps, weakness, or tiredness.

2. Beta-blockers

Beta-blockers lower your heart rate and your heart's blood output and workload, lowering your blood pressure.

There are various medications in this class, including:

  • Propranolol (Inderal)

  • Carvedilol (Coreg)

  • Atenolol (Tenormin)

  • Metoprolol succinate (Toprol-XL)

  • Metoprolol tartrate (Lopressor)

You may experience certain side effects of beta-blockers, including:

  • Depression

  • Tiredness

  • Insomnia

  • Asthma symptoms

  • Slow heartbeat

  • Impotence

  • Cold feet and hands

If you're taking insulin because you have diabetes, your doctor will want to closely monitor your response to treatment. Let your doctor know if you're considering pregnancy, or there's a chance you may be pregnant. If you become pregnant while on beta-blockers, let your doctor know so they can determine which medication is safest for you during your pregnancy.

3. ACE inhibitors

A chemical known as angiotensin narrows the arteries throughout your body, particularly in your kidneys. ACE inhibitors (ACE refers to angiotensin-converting enzyme) help your body make less angiotensin. This relaxes your blood vessels and opens them up, lowering blood pressure.

Various types of ACE inhibitors (ACEIs) include:

  • Enalapril maleate (Vasotec)

  • Benazepril hydrochloride (Lotensin)

  • Lisinopril (Zestril, Prinivil)

  • Fosinopril sodium (Monopril)

  • Captopril (Capoten)

You may experience certain side effects, such as:

  • Loss of taste

  • Skin rash

  • Chronic hacking, dry cough

  • Kidney damage (in rare instances)

Let your doctor know immediately if you're taking  ACEIs and you think you may be pregnant. ACE inhibitors can be dangerous during pregnancy for the fetus and the mother. They can cause severe kidney failure, low blood pressure, hyperkalemia (excess potassium), and even death of the fetus.

4. Angiotensin II receptor blockers (ARBs)

These block the angiotensin II action directly on blood vessels by attaching to the blood vessel's receptor site. This keeps them from narrowing, causing blood pressure to drop.

Types of ARBs include:

  • Irbesartan (Avapro)

  • Candesartan (Atacand)

  • Valsartan (Diovan)

  • Losartan potassium (Cozaar)

  • Eprosartan mesylate (Teveten)

  • Telmisartan (Micardis)

ARBs may cause dizziness. If you’re pregnant, you shouldn’t use them since they can injure the developing fetus. If you suspect you're pregnant, let your doctor know right away.

5. Calcium channel blockers

Muscle contractions involve the movement of calcium in and out of muscle cells. Calcium channel blockers (CCBs) limit how much calcium enters your blood vessels and heart's smooth muscle cells. CCBs help your heart beat with less force with every breath and relax your blood vessels, lowering your blood pressure.

Some types of CCBs include:

  • Diltiazem (Cardizem)

  • Amlodipine besylate (Lotrel, Norvasc)

  • Verapamil hydrochloride (Isoptin SR, Covera-HS, Verelan, Calan SR)

  • Felodipine (Plendil)

  • Isradipine (DynaCirc CR, DynaCirc)

Side effects may include:

  • Swollen ankles

  • Headache

  • Constipation

  • Dizziness

These are just some of the numerous prescription medications to treat high blood pressure. You can find additional information on these and other hypertension medications here¹.

  1. Types of blood pressure medications | American Heart Association

Prevention

How can you lower your risk of developing high blood pressure?

You can maintain healthy blood pressure by living a healthy lifestyle. By preventing hypertension, you reduce your risk of stroke and heart disease. Try to incorporate the following healthy living strategies into your daily routine:

1. Eat a healthy diet

To prevent hypertension and its complications, choose healthy snacks and meals. You'll want to include plenty of fresh vegetables and fruits.

Your doctor can suggest various foods that can prevent high blood pressure, such as foods rich in protein, fiber, potassium, and foods lower in saturated fat and sodium. Making healthy diet choices can maintain lower blood pressure and prevent complications for many.

The Dietary Approaches to Stop Hypertension (DASH)¹ eating plan has a proven track record of maintaining lower blood pressure.

2. Exercise

By being physically active, you can maintain low blood pressure and a healthy weight. According to the Physical Activity Guidelines for Americans², adults should get a minimum of two and a half hours of moderate-intensity exercise each week, such as bicycling or brisk walking. This is around a half-hour a day, five days a week. Adolescents and children should get one hour each day of physical activity.

3. Maintain a healthy weight

Being overweight or obese raises your risk for hypertension. Your doctor will measure your body mass index (BMI) to determine if you're in a healthy weight range or not. Or, you can use this tool³ to calculate your own BMI if you know your height and weight. Your doctor may also use your hip and waist measurements to evaluate body fat.

Consult with your doctor about ways to achieve and maintain a healthy weight.

4. Limit alcoholic beverages

Don't drink too much alcohol since it can increase your blood pressure. Men shouldn't drink more than two alcoholic beverages a day, and women shouldn't have more than one per day. You'll find more information about this and the CDC's Alcohol Program here⁴.

5. Don't smoke

Smoking increases your blood pressure. It also puts you at a greater risk for stroke and heart attack. You can lower your risk for heart disease by quitting. Talk with your doctor about ways to stop smoking.

6. Get sufficient sleep

Quality sleep is essential to your overall health. Getting enough sleep contributes to blood vessel and heart health. When you don't get enough sleep regularly, you face an increased risk⁵ of:

  • High blood pressure

  • Heart disease

  • Obesity

7.  Manage stress

Learning how to manage stress and relax can improve your physical and emotional health. It can also lower or prevent high blood pressure. Techniques for managing stress include:

  • Focusing on something peaceful or calm

  • Meditating

  • Listening to music

  • Exercising

  1. Your guide to lowering your blood pressure with DASH | NIH: National Heart, Lung, and Blood Institute

  2. Current guidelines | Health.gov

  3. Assessing your weight | Centers for Disease Control and Prevention

  4. Alcohol and public health | Centers for Disease Control and Prevention

  5. Sleep and sleep disorders | Centers for Disease Control and Prevention

Doctors & specialists

Your doctor will usually diagnose hypertension during your yearly visit to their office. They can provide you with a treatment plan and medication to lower your blood pressure to a manageable level. They'll also suggest lifestyle changes.

Over time, the impact of high blood pressure can cause other heart and vascular health-related symptoms. Your doctor will likely refer you to a cardiologist to monitor you. Cardiologists have special skills, experience, and training in finding, treating, and preventing heart and blood vessel diseases.

Your primary care doctor will work closely with your cardiologist to keep your blood pressure at a manageable level to prevent damage to important organs.


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