High Blood Pressure

Overview

Illustration of the cardiovascular system

What is high blood pressure?

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It’s normal for blood pressure to go up and down throughout the day, but if it stays up, you have high blood pressure. Another name for high blood pressure is hypertension.

When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. High blood pressure is called a "silent killer,'' because it doesn't usually cause symptoms while it is causing this damage.

Your blood pressure consists of two numbers: systolic and diastolic. Someone with a systolic pressure of 120 and a diastolic pressure of 80 has a blood pressure of 120/80, or "120 over 80."

  • The systolic number shows how hard the blood pushes when the heart is pumping.
  • The diastolic number shows how hard the blood pushes between heartbeats, when the heart is relaxed and filling with blood.

Adults should have a blood pressure of less than 120/80. High blood pressure is 140/90 or higher. Many people fall into the category in between, called prehypertension. People with prehypertension need to make lifestyle changes to bring the blood pressure down and help prevent or delay high blood pressure.

What causes high blood pressure?

In most cases, doctors can't point to the exact cause. But several things are known to raise blood pressure, including being very overweight, drinking too much alcohol, having a family history of high blood pressure, eating too much salt, and getting older.

Your blood pressure may also rise if you are not very active, you don't eat enough potassium and calcium, or you have a condition called insulin resistance.

What are the symptoms?

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.

Without treatment, high blood pressure can damage the heart, brain, kidneys, or eyes. This damage causes problems like coronary artery disease, stroke, and kidney failure.

Very high blood pressure can cause headaches, vision problems, nausea, and vomiting. These symptoms can also be caused by dangerously high blood pressure called malignant high blood pressure. It may also be called a hypertensive crisis or hypertensive emergency. Malignant high blood pressure is a medical emergency.

How is high blood pressure diagnosed?

Most people find out they have high blood pressure during a routine doctor visit. For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart.

You may have to check your blood pressure at home if there is reason to think the readings in the doctor’s office aren't accurate. You may have what is called white-coat hypertension, which is blood pressure that goes up just because you're at the doctor’s office. Even routine activities, such as attending a meeting, can raise your blood pressure. So can commuting to work or smoking a cigarette.

How is it treated?

Treatment depends on how high your blood pressure is, whether you have other health problems such as diabetes, and whether any organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease.

You can help lower your blood pressure by making healthy changes in your lifestyle. If those lifestyle changes don't work, you may also need to take pills. Either way, you will need to control your high blood pressure throughout your life.

  • If you have prehypertension, your doctor will likely recommend lifestyle changes. These may include losing extra weight, exercising, limiting alcohol, cutting back on salt, quitting smoking, and eating a low-fat diet that includes more fruits, vegetables, whole grains, and low-fat dairy foods.
  • If you have high blood pressure without any organ damage or other risk factors for heart disease, your doctor may recommend that you take medicine in addition to making lifestyle changes.
  • If you have high blood pressure and have some organ damage or other risk factors for heart disease, you may need to try various combinations of medicines in addition to making big lifestyle changes.

Most people take more than one pill for high blood pressure. Work with your doctor to find the right pill or combination of pills that will cause the fewest side effects.

It can be hard to remember to take pills when you have no symptoms. But your blood pressure will go back up if you don't take your medicine. Make your pill schedule as simple as you can. Plan times to take them when you are doing other things, like eating a meal or getting ready for bed.

What can you do to prevent high blood pressure?

Making lifestyle changes can help you to prevent high blood pressure. You can:

  • Stay at a healthy weight or lose extra weight.
  • Eat less salt and salty foods.
  • Exercise regularly.
  • Drink alcohol moderately. Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
  • Follow the DASH eating plan (Dietary Approaches to Stop Hypertension). This diet is rich in fruits, vegetables, and low-fat dairy products and is low in fat.

Cause

Experts know that many different factors are linked to high blood pressure. But experts still don't fully understand the exact cause. Factors that are linked to high blood pressure include:

  • Aging.
  • Drinking more than 2 alcohol drinks a day for men or more than 1 alcohol drink a day for women.
  • Eating a lot of sodium (salt).
  • Being overweight or obese.
  • Having high cholesterol.
  • Not exercising.
  • Being under a lot of stress.
  • Eating a diet low in potassium, magnesium, and calcium.
  • Being insulin-resistant.

Primary, or essential, high blood pressure accounts for almost all cases of hypertension. Secondary high blood pressure, which is caused by another disease or medicine, is less common.

Elevated blood pressure readings may not always mean that you have high blood pressure. For some people, just being in a medical setting causes their blood pressure to rise. This is called white-coat hypertension.

More information

Symptoms

People with primary (essential) high blood pressure usually do not have any symptoms. Most people with high blood pressure feel fine. It's during a routine exam or a doctor visit for another problem that they find out they have high blood pressure.

Very severe high blood pressure (160 over 100 or higher) may lead to malignant high blood pressure. This is also called hypertensive emergency or hypertensive crisis. Very severe high blood pressure is a medical emergency. Symptoms of very severe high blood pressure include:

  • Headaches, especially pulsating headaches behind the eyes that occur early in the morning.
  • Visual disturbances.
  • Nausea and vomiting.

Over time, untreated high blood pressure can damage organs, such as the heart, kidneys, or eyes. This may lead to:

What Happens

Healthy arteries have smooth inner walls. Your blood flows through them without a problem. The blood vessels stay strong and flexible.

But when you have high blood pressure, blood flows through your arteries with too much force, even though you can't feel it. Over time, this damages the walls of your arteries. They aren't smooth anymore. They get rough spots on them where fat and calcium start to build up. This buildup is called plaque (say "plak").

Plaque makes your arteries narrower. It also makes them stiffer. Blood can't flow through them as easily. This lack of good blood flow starts to damage some of the organs in your body. See a picture of how high blood pressure damages arteries.

This damage leads to:

This damage doesn't happen all at once. It happens slowly over time. But you can't tell that it's happening, because you don't feel anything.

Other types of high blood pressure

  • Prehypertension . This is blood pressure that is higher than normal but not high enough to be high blood pressure (between 120/80 and 140/90). It is a warning that your blood pressure is going up. People with this type of blood pressure are more likely to get high blood pressure and heart disease than people with normal blood pressure.
  • Secondary high blood pressure . Sometimes high blood pressure is caused by something else, such as kidney disease, pregnancy, or medicine.
  • Isolated systolic high blood pressure. This means that systolic blood pressure (the first number in a blood pressure reading) is higher than 140, but diastolic blood pressure (the second number) stays lower than 90. This type of high blood pressure is more common in older adults, especially older women.

Some people only have high blood pressure when they're at the doctor’s office. This is called white-coat hypertension. If your doctor thinks this is getting in the way of measuring your true blood pressure, you may need to get your blood pressure measured away from the doctor's office.

Very high blood pressure is called malignant high blood pressure. It is so high that it can damage organs like the eyes and kidneys. It is an emergency. It may happen if someone suddenly stops taking blood pressure medicine or misses a dose of medicine. It may be caused by a medicine or another condition. Or the cause may not be known. This problem is also called hypertensive crisis or hypertensive emergency.

What Increases Your Risk

Risk factors for high blood pressure include:

  • A family history of high blood pressure.
  • Aging.
  • Eating a lot of sodium (salt).
  • Drinking more than 2 alcohol drinks a day for men or more than 1 alcohol drink a day for women.
  • Being overweight or obese.
  • Lack of exercise or physical activity.
  • High cholesterol.
  • 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 is not known.

Other possible risk factors include:

  • Low intake of potassium, magnesium, and calcium.
  • Sleep apnea and sleep-disordered breathing.
  • Long-term use of pain medicines like NSAIDs—for example, naproxen (such as Aleve) or ibuprofen (such as Motrin or Advil)—or COX-2 inhibitors, such as celecoxib (Celebrex). Aspirin does not increase your risk for getting high blood pressure.

People who have high blood pressure along with any of the following risk factors are at increased risk for getting complications, such as coronary artery disease, heart attack, stroke, kidney failure, and eye damage (retinopathy). These risk factors are:

  • Cigarette smoking.
  • High cholesterol or low HDL ("good") cholesterol.
  • Diabetes .
  • Having one or more close relatives who have or had early coronary artery disease.
  • Being a male.
  • Being an African American.
  • Being overweight.
  • Not getting enough exercise.

When to Call a Doctor

Call a doctor immediately if you have high blood pressure and:

  • Your blood pressure is 180/110 or higher.
  • You think high blood pressure is causing headaches or other symptoms.

Call a doctor if:

  • Your blood pressure is 140/90 or higher on two or more occasions.
  • You think you may be having side effects from your blood pressure medicine.
  • Your blood pressure is usually normal and well controlled, but it goes above the normal range on more than one occasion.

Adults are encouraged to have their blood pressure checked regularly.

Who to See

Your blood pressure can be checked:

  • At a clinic where you work or go to school.
  • At health fairs, fitness centers, community centers, fire stations, and ambulance stations.
  • By a nurse practitioner or physician assistant.
  • By a primary care doctor.

For diagnosis and management of high blood pressure, see:

More information

Exams and Tests

The main test for high blood pressure is simple, fast, and painless. These are the usual steps:

  1. You sit quietly for 5 minutes before the test, with both feet flat on the floor.
  2. You sit down with your arm resting on the arm of the chair so that the arm is level with your heart.
  3. An inflatable sleeve, called a cuff, is wrapped around your upper arm. It’s attached to a dial that will show your blood pressure numbers.
  4. The nurse (or other health professional) seals the cuff and pumps it up. You feel tight pressure as the cuff cuts off the blood flow in your arm.
  5. Next, the nurse slowly loosens the cuff while using a stethoscope to listen to the heartbeat in your inner elbow. When the cuff is just loose enough that blood starts to flow again and the nurse can hear it, that is your systolic blood pressure.
  6. The cuff is slowly loosened some more. When it’s loose enough that your heartbeat can no longer be heard through the stethoscope, that is your diastolic blood pressure.

If this test shows that your blood pressure is high, your doctor will likely have you come in two more times to be tested. This will confirm that you have high blood pressure.

Some people only have high blood pressure when they're at the doctor’s office. This is called white-coat hypertension. If your doctor thinks this is getting in the way of measuring your true blood pressure, you may need to get your blood pressure measured away from the doctor's office.

Regular blood pressure checks

All adults should have their blood pressure checked regularly. Experts recommend:1

  • At least every 1 to 2 years if your blood pressure is normal (119/79 or lower).
  • At least every year—or as often as your doctor recommends—if you have prehypertension. This means your systolic pressure (the first number) is 120 to 139 and your diastolic pressure (the second number) is 80 to 89.
  • More oftenif you have other risk factors for heart disease or evidence of disease caused by high blood pressure.

The automated devices you find in grocery stores or drugstores may not be accurate. Having your blood pressure checked at the doctor's office is best.

A home blood pressure monitor makes it easy to keep track of your blood pressure. It's a good idea to bring your home monitor to the doctor's office to check its accuracy. For more information, see:

Click here to view an Actionset. High blood pressure: Checking your blood pressure at home.

Other tests

Besides taking your blood pressure, your doctor will do a physical exam and ask you questions about your medical history. Your doctor may also have you get other tests to find out whether high blood pressure has damaged any organs or caused other problems. These tests may include:

In some cases, you may be asked to check your blood pressure at home and keep a record of the readings. If you can't do this, you may need ambulatory blood pressure monitoring. This means wearing a special device for 24 to 48 hours. The device automatically takes your blood pressure throughout the day.

Sometimes doctors automatically schedule routine tests because they think that's what patients expect. But experts say that routine heart tests can be a waste of time and money. For more information, see Heart Tests: When Do You Need Them?

Secondary high blood pressure

Secondary high blood pressure is high blood pressure that is caused by another disease or condition. It can also be caused by certain medicines. Your doctor may suspect that you have secondary high blood pressure if:

  • Your blood pressure has suddenly gone up since it was last checked.
  • You are young and your blood pressure is 160/100 or higher.
  • You have had many treatments and medicines for high blood pressure, but it is still 160/100 or higher.
  • You have symptoms of conditions that may raise blood pressure, such as obesity or muscle weakness from Cushing's syndrome.
  • Your kidneys don't work as well as they should.

If your doctor thinks that you may have secondary high blood pressure, you may need tests to diagnose other health problems. Your doctor will also check any medicines that you take, since some medicines can cause high blood pressure as a side effect.

Treatment Overview

Untreated high blood pressure can lead to fatal heart attacks or strokes. The higher your blood pressure, the greater your risk. Lowering blood pressure lowers the risk of damaging blood vessels and getting atherosclerosis.

High blood pressure usually can't be cured. But it can be controlled. The two types of treatment for high blood pressure are:

  • Lifestyle changes, including healthy eating, losing extra weight, and getting more active.
  • Daily medicines.

For most people, the goal of treatment is to get the blood pressure below 140/90. But a person's goal may be lower. Your doctor will give you a blood pressure goal that is based on your health. For example, your goal may be lower if you have other conditions such as diabetes, heart failure, coronary artery disease, or chronic kidney disease

Treating high blood pressure usually is a lifelong effort.

Treatment for high blood pressure

Blood pressure

Treatment

Blood pressure of 120–139 over 80–89 (prehypertension):

Lifestyle changes.

High blood pressure of 140–159 over 90–99 (stage 1):

Lifestyle changes, possibly medicines.

High blood pressure of 160 over 100 or higher (stage 2):

Medicines plus lifestyle changes.

High blood pressure plus organ damage or other risk factors for heart disease:

Medicines plus serious lifestyle changes and treatment for the other health problems.

Secondary high blood pressure:

Medicines, treatment of the condition causing your high blood pressure, or both.

Treating high blood pressure with lifestyle changes

Your doctor may suggest that you make one or more of the following changes:

Photo of a woman

One Woman's Story:

Izzy, 60

"I could never have imagined I could get (my blood pressure) down so low by losing weight. I feel sure it was the WAY I lost weight, with DASH."—Izzy

Read more about Izzy and how she uses the DASH eating plan.

Treating high blood pressure with medicines

If lifestyle changes don't work to lower your blood pressure, you probably need to take daily medicines as well.

Medicines control—but usually don't cure—high blood pressure. So you will probably need to take them for the rest of your life. Most people need to take two or more medicines.

For more information, see:

Click here to view a Decision Point. High blood pressure: Should I take medicine?

Some people find it hard to take their medicines properly. They may fit into one of these groups:

  • "Why should I bother?" These people don't see why they should take medicines every day when they don't feel sick.
    High blood pressure doesn't usually make you feel sick. But it's important to treat high blood pressure, because it damages your organs, even though you can't feel anything.
  • "I don't like the side effects." These people stop taking their medicines because they are having side effects from the pills.
    If you're having side effects, tell your doctor. There are many kinds of medicines you can try until you find one that works well with the fewest side effects.
  • "I just can't keep track." Some people find it very hard to keep track of taking two or more pills every day, especially if they need to take them at different times.
    Your doctor may be able to change your pill schedule to make it simpler. You can also organize your pills with a pillbox that holds a week's worth of pills. Some of these boxes have separate compartments for morning, noon, and bedtime pills.

For more information, see the topics:

Photo of a man

One Man's Story:

Tyrell, 35

"I learned that it doesn't matter how healthy you feel—if you have high blood pressure, you're sick and you'd better do something about it."—Tyrell

Read more about Tyrell and why he started taking his medicines properly.

If you have trouble taking high blood pressure medicines for any reason, talk to your doctor.

For more information, see:

Click here to view an Actionset. High blood pressure: Taking medicines properly.

People who need special treatment

Some people with high blood pressure need special treatment:

Treatment of secondary high blood pressure depends on the cause. For example, treatment of high blood pressure caused by kidney disease will also include treating the kidney problem. Even if the condition that caused your high blood pressure is treated, you may still have to take blood pressure medicine throughout your life.

Prevention

Lifestyle changes can help you prevent high blood pressure. These changes are especially important for people who have risk factors for high blood pressure that cannot be changed, including family history, race, or age.

Lifestyle changes include:

Living With High Blood Pressure

Photo of a man

One Man's Story:

Arturo, 58

"I can't tell you how much easier it is to go on my walks every day because of my wife. Even when I'm feeling kind of lazy, I feel like she's counting on me, so I do it for her as well as for me."—Arturo

Read more about Arturo and how he got support for making lifestyle changes.

Lifestyle changes are important to help control high blood pressure, especially if you have other risk factors for heart disease and stroke.

Even if your doctor has prescribed medicine for you, you can still take many steps at home to lower your blood pressure and reduce your risk. Some people can even take less medicine after making these changes.

What changes do you need to make?

Make these lifestyle changes to help lower your blood pressure:

How do you make lifestyle changes?

Photo of a woman

One Woman's Story:

Izzy, 60

“A big lesson I learned is that everything we do routinely is a habit. And habits can be changed. I'm living proof.”—Izzy

Read more about Izzy and how she changed her eating habits.

Making any kind of change in the way you live your daily life is like being on a path. The path leads to success. Here are the first steps on that path:

  1. Have your own reason for making a change. If you do it because someone else wants you to, you're less likely to have success.
  2. Set goals. Include long-term goals as well as short-term goals that you can measure easily.
  3. Measure improvements to your health. For example, keep track of your blood pressure, cholesterol, or blood sugar. Or see how you can shorten the time it takes to walk a mile.
  4. Think about what might get in your way, and prepare for slip-ups.
  5. Get support from your family, your doctor, your friends—and from yourself.

1. Have your own reason

Your reason for wanting to make a lifestyle change is really important. When you have high blood pressure, the reason for making lifestyle changes is clear: to lower your blood pressure.

But it's very important that you feel ready to make changes. If you don't feel ready now, learn more about high blood pressure and the damage it can do. When you truly want to make changes, you're ready for the next step.

It's not easy to change habits. But taking the time to really think about what will motivate or inspire you will help you reach your goals.

2. Set goals you can reach

Ask yourself if you feel ready to begin taking steps toward big goals. If you're not ready yet, try to pick a date when you will start making small changes. Any healthy change—no matter how small—is a good start.

When you are clear about your reasons for wanting to make a change, it's time to set your goals.

  • Long-term goals: These are large goals that you want to reach in 6 to 12 months. Your doctor can help you figure out what your long-term goals should be for your blood pressure.
  • Short-term goals: What are the short-term goals that will help you reach your long-term goals? Short-term goals are the small steps you take, week by week, to improve your health.
  • Updated goals: To help you stay motivated, track your progress and update your goals as you move forward.

Tips for setting goals

  • Focus on small goals. This will help you reach larger goals over time. With smaller goals, you'll have success more often, which will help you stay with it.
  • Write down your goals. This will help you remember, and you'll have a clearer idea of what you want to achieve. Use a personal action plan(What is a PDF document?) to record your goals. Hang up your plan where you will see it often as a reminder of what you're trying to do.
  • Make your goals specific. Specific goals help you measure your progress. For example, setting a goal to eat 5 helpings of fruits and vegetables every day is better than a general goal to "eat more vegetables."
  • Focus on one goal at a time. By doing this, you're less likely to feel overwhelmed and then give up.
  • When you reach a goal, enjoy your new behavior and success for several days and then think about setting your next goal.

3. Measure how your health has improved

Before you make lifestyle changes, ask your doctor to check your blood pressure. Then, as you start to make changes, have your blood pressure checked often, and keep track of the numbers. You can:

  • Visit your doctor's office every week. Most clinics will gladly check a patient's blood pressure for free.
  • Check your blood pressure at home. You can buy a home blood pressure monitor that is easy to use.
    Click here to view an Actionset.High blood pressure: Checking your blood pressure at home
  • Use an automatic blood pressure device at a local drugstore or grocery store. Although these devices aren't always accurate, if you use one regularly you may be able to see if your blood pressure goes down.

4. Prepare for slip-ups

Photo of a man

One Man's Story:

Tyrell, 35

"For a few months I was really good about taking (my pills) every day. But they made me a little tired, and I got tired of being tired."—Tyrell

Read more about Tyrell and why he returned to taking his medicine every day.

It's perfectly normal to try to change a habit, go along fine for a while, and then have a setback. Lots of people try and try again before they reach their goals.

What are the things that might cause a setback for you? If you have tried to make lifestyle changes before, think about what helped you and what got in your way.

By thinking about these barriers now, you can plan ahead for how to deal with them if they happen.

Here's one person's list of barriers to taking a brisk 30-minute walk every day, along with some possible solutions:

Barriers

Solutions

"I might be too busy."

  • My backup plan will be to break my usual 30-minute walk into two 15-minute walks or three 10-minute walks.

"I might get bored."

  • I'll listen to music or a podcast while I walk.
  • I'll get my neighbor to walk with me.

"It might rain."

  • My backup plan will be to use an exercise DVD or a treadmill in front of my TV when the weather's bad.

Use a personal action plan(What is a PDF document?) to write down your barriers and backup plans.

There will be times when you slip up and don't make your goal for the week. When that happens, don't get mad at yourself. Learn from the experience. Ask yourself what got in the way of making your goal. Positive thinking goes a long way when you're making lifestyle changes.

Click here to view an Actionset. Positive thinking: Stopping unwanted thoughts

4. Get support

The more support you have for making lifestyle changes, the easier it is to make those changes.

Photo of a man

One Man's Story:

Arturo, 58

"As soon as I mentioned (to my wife) that I needed help, she got out a pen and some paper and started writing out a walking schedule."—Arturo

Read more about Arturo and how he got support for his lifestyle changes.

Tips for getting support

  • Get a partner. It's motivating to know that someone is trying to make the same lifestyle change that you're making, like being more active or changing your eating habits. You have someone who is counting on you to help him or her succeed. That person can also remind you how far you've come.
  • Get friends and family involved. They can exercise with you or encourage you by saying how they admire you. Family members can join you in your healthy eating efforts. Don't be afraid to tell family and friends that their encouragement makes a big difference to you.
    Click here to view an Actionset.Healthy eating: Getting support when changing your eating habits
    Click here to view an Actionset.Quitting smoking: Getting support
  • Join a class or workout group. People in these groups often have some of the same barriers you have. They can give you support when you don't feel like staying with your plan. They can boost your morale when you need a lift. You'll also find a number of online support groups for people with high blood pressure.
  • Give yourself positive reinforcement. When you feel like giving up, don't waste energy feeling bad about yourself. Remember your reason for wanting to change, think about the progress you've made, and give yourself a pep talk and a pat on the back.
  • Get professional help. A registered dietitian can help you make your diet healthier while still allowing you to eat foods that you enjoy. An exercise physiologist can help design an exercise program that is fun and easy to stay on. A psychiatrist, a psychologist, a social worker, or your doctor can help you overcome hurdles, reduce stress, or quit smoking.

You can use this personal action plan(What is a PDF document?) to organize your support system.

Medications

Deciding whether to treat high blood pressure with medicine and choosing the best medicine are based mainly on:

  • How high your blood pressure is.
  • Whether you have signs that high blood pressure has caused organ damage, such as an enlarged heart or early damage to your arteries, kidneys, or eyes.
  • Whether you have other medical conditions, such as coronary artery disease, diabetes, or kidney or lung disease or risk factors for heart disease, such as diabetes or high cholesterol.
  • Whether you think you can succeed at making lifestyle changes.

Doctors may have different opinions about when to start medicines for high blood pressure.

  • Lifestyle changes alone may be tried before medicine if you have prehypertension (120–139/80–89 millimeters of mercury [mm Hg]) or high blood pressure (140/90 mm Hg), if you do not have other risk factors for heart disease, and if there's no evidence of organ damage.
  • Treatment with medicine is often started along with lifestyle changes if you have other risk factors for heart disease, if there are signs of damage to organs, or if you have stage 1 or 2 high blood pressure.

Doctors usually prescribe a single, low-dose medicine first. If blood pressure is not controlled, your doctor may change the dosage or try a different medicine or combination of medicines. It is common to try several medicines before blood pressure is successfully controlled. Many people need more than one medicine to get the best results. African Americans with blood pressure that is higher than 10 to 15 mm Hg above their goal may need to take a combination of medicines first.3 For more information, see:

Click here to view a Decision Point. High blood pressure: Should I take medicine?

Medicine Choices

Medicine choices include:

All of these medicines are effective for lowering the risk of heart attack and stroke.

Treatment for high blood pressure is different for each person and is based on your risk factors, such as diabetes, smoking, and heart disease. Although one study may recommend a particular medicine as the first line of treatment, it may not be best for you based on your medical condition.

What's most important is that you work with your doctor to find the right medicine or combination of medicines that have the fewest side effects and work well for you, and that you take your medicines regularly as prescribed.

Click here to view an Actionset. High blood pressure: Taking medicines properly

High blood pressure guidelines from the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommend that, for most people, one of the medicines be a thiazide-type diuretic.

If other conditions, such as heart failure or diabetes, are present, ACE inhibitors or ARBs often are used as the first line of therapy, because the other medical conditions also may benefit from these medicines. But isolated systolic hypertension may respond best to diuretics alone.

What to Think About

  • Your doctor may choose which medicine to give you for high blood pressure based on whether you have any other related conditions. For example, doctors often prescribe ACE inhibitors for people with diabetes or heart failure.
  • Some people who get a cough while taking ACE inhibitors do well with ARBs, which usually do not cause a cough.
  • Strategies for treating high blood pressure in pregnant women are quite different. For more information, see the topic Preeclampsia and Hypertension During Pregnancy.
  • Some experts believe that a combination of medicines, each given in a lower dose, is better for reducing blood pressure than a higher dose of a single medicine. Because the medicines that are combined are given in a lower dose, there may be fewer side effects.

Check with your doctor before you take any nonsteroidal anti-inflammatory drugs (NSAIDs)—for example, aspirin or ibuprofen—with high blood pressure medicines. NSAIDs may raise blood pressure and keep your blood pressure medicines from working well.

More information

Other Treatment

In addition to making lifestyle changes, you can also try several other nondrug methods of reducing blood pressure.

  • None of the methods listed below are proved to consistently lower high blood pressure. But these methods generally are considered to be safe and may have other benefits besides lowering blood pressure.
  • Although there may be a link between a certain stressful situation and high blood pressure, this does not prove that changing the situation will affect blood pressure.
  • Because it is simple to check your blood pressure, you can easily track the effects of these treatment methods on lowering your blood pressure. See:
    Click here to view an Actionset.High blood pressure: Checking your blood pressure at home.

Other Treatment Choices

Alternative or complementary medicine treatments that help reduce stress and improve quality of life may have some effect on blood pressure. These treatments include:

Although eating garlic and onions has been recommended to reduce blood pressure, evidence shows that only very small decreases in blood pressure may result. Fish oil (omega-3 fatty acids) also may have some effect on lowering blood pressure.

Not eating enough foods containing potassium, calcium, and magnesium may contribute to high blood pressure. Most people will get enough of these minerals by eating a balanced diet that contains plenty of fresh fruits, vegetables, dairy foods, whole grains, and legumes (cooked dried beans and peas). Taking supplements instead of eating these foods does not have the same effect.

What to Think About

Many of the complementary medicine options listed above don't cost much and are probably not harmful. But it is best to work with your doctor when using these other methods along with traditional medical treatments.

The safest way to ensure good nutrition is through a balanced, varied diet instead of through nutritional supplements.

Acupuncture is currently being studied, and it shows some promise in lowering blood pressure.4

Other Places To Get Help

Organizations

American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.americanheart.org
 

Call the American Heart Association (AHA) to find your nearest local or state AHA group. AHA can provide brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support. AHA's Web site also has information on physical activity, diet, and various heart-related conditions.


HeartHub
Web Address: www.hearthub.org
 

HeartHub is a patient Web site from the American Heart Association. It provides patient-focused information, tools, and resources about heart diseases and stroke. The site helps you understand and manage your health. It includes online tools that explain your risks and treatment options. The site includes articles, the latest news in health and research, videos, interactive tools, forums and community groups, and e-newsletters.

The Web site includes health centers that cover heart rhythm problems, cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart failure, high blood pressure, peripheral artery disease, and stroke.

HeartHub also links to Heart360.org, another American Heart Association Web site. Heart360 is a tool that helps you send and receive medical information with your doctor. It also helps you monitor your health at home. It gives you access to tools to manage and monitor high blood pressure, diabetes, high cholesterol, physical activity, and nutrition.


National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
E-mail: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

References

Citations

  1. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express (NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and Human Services.
  2. Simon HB (2003). Diet and exercise. In DC Dale, DD Federman, eds., Scientific American Medicine, Clinical Essentials, chap. 4. New York: WebMD.
  3. Douglas JG (2005). Clinical guidelines for the treatment of hypertension in African Americans. American Journal of Cardiovascular Drugs, 5(1): 1–6.
  4. Flachskampf FA, et al. (2007). Randomized trial of acupuncture to lower blood pressure. Circulation, 115(24): 3121–3129.

Other Works Consulted

  • American Heart Association. (2005). Recommendations for blood pressure measurement in humans and experimental animals. Part 1: Blood pressure measurement in humans. AHA Scientific Statement. Hypertension, 45(1): 142–161.
  • Appel LJ, et al. (2006). Dietary approaches to prevent and treat hypertension: A scientific statement from the American Heart Association. Hypertension, 47(2): 296–308.
  • Drugs for hypertension (2009). Treatment Guidelines From The Medical Letter, 7(77): 1–10.
  • Falkner B, Daniels SR (2004). Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension, 44(4): 387–388.
  • Henri HC, Rudd P (2007). Hypertension: Context and management. In EJ Topol, ed., Textbook of Cardiovascular Medicine, 3rd ed., pp. 88–108. Philadelphia: Lippincott Williams and Wilkins.
  • National Heart, Lung, and Blood Institute (2006). Your Guide to Lowering Your Blood Pressure With DASH (NIH Publication No. 06-4082). Available online: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf.
  • Rashidi A, et al. (2008). Diagnosis and treatment of hypertension. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 1610–1629. New York: McGraw-Hill Medical.
  • Rosendorff C, et al. (2007). Treatment of hypertension in the prevention and management of ischemic heart disease: A scientific statement from the American Heart Association Council for High Blood Pressure Research and the Council on Clinical Cardiology and Epidemiology and Prevention. Circulation, 115(21): 2761–2788.
  • Schwartz GL, Sheps SG (2006). Hypertension. In DC Dale, DD Federman, eds., ACP Medicine, section 1, chap 3. New York: WebMD.
  • Sheridan SL (2007). Primary prevention: Hypertension, search date March 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  • Victor RG (2008). Arterial hypertension. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 23rd ed., pp. 430–450. Philadelphia: Saunders.

Credits

Author Robin Parks, MS
Author Cynthia Tank
Editor Kathleen M. Ariss, MS
Editor Marianne Flagg
Associate Editor Pat Truman, MATC
Associate Editor Michele Cronen
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Specialist Medical Reviewer Ruth Schneider, MPH, RD - Diet and Nutrition
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Updated April 10, 2009

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