What is high blood pressure?

It's normal for blood pressure to go up and down throughout the day. But if it stays up, you have high blood pressure (hypertension). High blood pressure means that your blood is pressing on your arteries with too much force. For diagnosis, the top number may be 130 to 140 or higher. The bottom number may be 80 to 90 or higher.

Usually it doesn't cause symptoms. But over time, it can cause damage. High blood pressure increases the risk of stroke, heart attack, vision loss, and dementia.

Your doctor will give you a goal for your blood pressure. Your goal will be based on your health and your age.

A healthy lifestyle, which includes eating healthy and being active, is always important to help lower blood pressure. You might also take medicine to reach your blood pressure goal.

High blood pressure doesn't usually cause symptoms. Most people don't know they have it until they go to the doctor for some other reason. Very high blood pressure (such as 180/120 or higher) can cause severe headaches and vision problems.

• Your doctor will suggest making lifestyle changes to help your heart. For example, your doctor may ask you to eat healthy foods, quit smoking, lose extra weight, and be more active.
• If lifestyle changes don’t help enough, your doctor may recommend that you take medicine.
• When blood pressure is very high, medicines are needed to lower it.

A heart-healthy lifestyle can help you prevent high blood pressure. These changes are even more important if you have risk factors for high blood pressure that you can't change. These risk factors include race, age, and having others in your family who have high blood pressure.

Here are some things you can do.

• Stay at a healthy weight.
• Eat heart-healthy foods, and limit sodium.
• Get regular exercise.
• Limit alcohol to 2 drinks a day for men and 1 drink a day for women.

During a routine visit, your doctor will measure your blood pressure. Your doctor may ask you to test it again when you are home. This is because your blood pressure can change throughout the day. To diagnose high blood pressure, your doctor needs to know if your blood pressure is high throughout the day.

Doctors usually first prescribe a single, low-dose medicine for high blood pressure. If this doesn't work, your doctor may change the dosage or try a different medicine or combination of medicines. It's common to try several medicines before blood pressure is controlled. Many people need more than one medicine to get the best results.

You may have regular blood tests to monitor how the medicine is working in your body. Your doctor will likely let you know when you need to have the tests.

You may need to avoid some medicines that you can buy without a prescription. For example, check with your doctor before you take any nonsteroidal anti-inflammatory drugs (NSAIDs) if you are taking medicines for high blood pressure. NSAIDs include naproxen and ibuprofen. NSAIDs may raise blood pressure and keep your blood pressure medicines from working well. They may also interact with your blood pressure medicine and cause kidney problems.

Medicine choices

The first medicines used may be:

• ACE inhibitors.
• Thiazide diuretics.
• Calcium channel blockers.
• Angiotensin II receptor blockers (ARBs).

Other medicines used include:

• Beta-blockers.
• Alpha-blockers.
• Vasodilators.

All of these medicines work well to lower the risk of heart attack and stroke.

Your blood pressure can be checked:

• At a clinic where you work or go to school.
• At pharmacies, health fairs, fitness centers, community centers, fire stations, and ambulance stations.
• By medical professionals, including nurse practitioners, physician assistants, and primary care doctors.

For diagnosis and management of high blood pressure, see:

• A primary care doctor.
• An internist.
• A cardiologist. In general, a cardiologist is needed only in cases of extremely high blood pressure or when the person has other serious heart problems.
• A nephrologist (kidney specialist), in extreme cases.
• A nurse practitioner.
• A physician assistant.

Things that increase your risk (risk factors) for high blood pressure include:

• Having other people in your family who have high blood pressure.
• Aging.
• Eating a lot of sodium (salt).
• Drinking more than 2 alcoholic drinks a day for men or more than 1 alcoholic drink a day for women.
• Being overweight or obese.
• Not getting exercise or physical activity.
• Race. African Americans are more likely to get high blood pressure, often have more severe high blood pressure, and are more likely to get the condition at an earlier age than others. Why they are at greater risk isn't known.

Other possible risk factors include:

• Sleep apnea and sleep-disordered breathing.
• Certain medicines, such as birth control pills, amphetamines, some antidepressants, steroids, and some nonsteroidal anti-inflammatory drugs (NSAIDs).

• Blood flows through your arteries with too much force. Over time, this can damage the heart and the walls of your arteries. But you can’t feel it. High blood pressure usually doesn’t cause symptoms.
• High blood pressure makes your heart work harder. And that can lead to heart failure, which means your heart doesn't pump as much blood as your body needs.
• Fat and calcium start to build up in your arteries. This buildup is called hardening of the arteries. It can cause many problems including a heart attack and stroke.
• Arteries also carry blood and oxygen to organs like your eyes, kidneys, and brain. If high blood pressure damages those arteries, it can lead to vision loss, kidney disease, stroke, and a higher risk of dementia.

Complementary treatments haven't been proven to lower high blood pressure. But these treatments may be used to help manage stress and improve quality of life.

Tell your doctor if you use, or plan to use, complementary treatments to help manage your blood pressure. These treatments don't replace lifestyle changes or medicine for high blood pressure. You use this type of treatment in addition to your doctor's standard care. You and your doctor can decide which treatment might be best for you.

Complementary treatments include:

• Acupuncture.
• Biofeedback.
• Meditation.
• Stress management and relaxation.
• Yoga.

Most mind and body practices—such as acupuncture and yoga—are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.

Experts don't fully understand the exact cause of high blood pressure. But they know that some things are linked to it. These include aging, drinking too much alcohol, eating a lot of sodium (salt), being overweight, and not exercising.

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries. It's normal for blood pressure to go up and down throughout the day. But if it stays up, you have high blood pressure (hypertension).

Two numbers tell you your blood pressure. The first (top) number is the systolic pressure. It shows how hard the blood pushes when your heart is pumping. The second (bottom) number is the diastolic pressure. It shows how hard the blood pushes between heartbeats, when your heart is relaxed and filling with blood.

High blood pressure means that the top number stays high, or the bottom number stays high, or both. For diagnosis, the top number may be 130 to 140 or higher. The bottom number may be 80 to 90 or higher.

High blood pressure increases the risk of stroke, heart attack, and other problems.

Some over-the-counter (OTC) medicines can raise your blood pressure or keep your blood pressure medicine from working the way it should. So if you have high blood pressure or other heart or blood vessel problems, you need to be careful with OTC medicines. That includes vitamins and supplements. Your doctor or pharmacist can suggest OTC medicines that are safe for you.

Some common types of OTC medicines you may need to avoid include:

• Decongestants, such as those that contain pseudoephedrine.
• Pain medicines (NSAIDs), such as ibuprofen and naproxen.
• Cold and flu medicines. These often contain decongestants and NSAIDs.
• Some antacids and other stomach medicines. Many of these are high in sodium, which can raise blood pressure. So be sure to read labels carefully to check for sodium content.
• Some herbal remedies and dietary supplements. Examples are ephedra, ma huang, and bitter orange.

How can you know if it's safe to take an over-the-counter medicine?

Always talk with your pharmacist or doctor before you take any new OTC medicine or supplement. He or she can:

• Check to make sure that the medicine won't interact with your blood pressure medicine.
• Suggest OTC medicines that won't affect your blood pressure.

It's also important to make a list of all the medicines you take. Bring it to each appointment, and ask your doctor to review it. Be sure to include all your prescription medicines, OTC medicines, vitamins, and herbal and dietary supplements.

Long-term (chronic) kidney disease happens when the kidneys cannot remove waste and keep your body's fluids and chemicals in balance. Usually, the kidneys remove waste from the blood through the urine. When the kidneys are not working well, waste can build up so much that it poisons the body. Kidney disease can make you very tired. It also can cause swelling, or edema, in your legs or other areas of your body.

High blood pressure is one of the major causes of chronic kidney disease. And kidney disease can also cause high blood pressure. No matter which came first, having high blood pressure damages the tiny blood vessels in the kidneys.

If you have high blood pressure, it is important to lower it. There are many things you can do to lower your blood pressure, which may help slow or stop the damage to your kidneys.