High Blood Pressure
(Essential Hypertension; Hypertension; Blood Pressure, High; High Blood Pressure; Idiopathic Hypertension; Primary Hypertension)
High blood pressure (hypertension) is when the force on the blood vessel walls is too high. Blood pressure measurement includes two numbers:
- Systolic pressure: top number, normal reading is 120 millimeters of mercury (mmHg) or less
- Diastolic pressure: bottom number, normal reading is 80 mmHg or less
Blood pressure categories are:
Elevated, but not yet high blood pressure:
- Systolic pressure is 120-129 mmHg and the
- Diastolic pressure is 80 mmHg
- Systolic pressure is 130-139 mmHg and/or
- Diastolic pressure is 80-89 mmHg
- Systolic pressure is greater than or equal to 140 mmHg and/or
- Diastolic pressure is greater than or equal to 90 mmHg
High blood pressure puts stress on the heart, lungs, brain, kidneys, and blood vessels. Over time, this can cause severe health problems. Early treatment can improve outcomes.
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The body has many steps to help keep blood pressure in a healthy range. It is not clear what changes happen that lead to high blood pressure. Things that may play a role are:
- Lack of physical activity
- Being overweight or obese
This problem usually starts when a person is between 20 and 50 years of age. The risk increases with age. Other things that may raise the risk are:
Most people do not have symptoms until blood pressure is very high. Problems may be:
- Blurry or double vision
- Belly pain
- Chest pain
- Shortness of breath
High blood pressure is often found during a doctor's visit. If the reading is high, you will come back for repeat checks. High blood pressure will be confirmed after more than two readings over more than two visits.
A doctor's office can make some people nervous. This can cause higher than normal blood pressure. You may be asked to measure your blood pressure at home or in another location.
The goal of treatment is to lower blood pressure. The methods used may need to be changed over time. Choices are:
Lifestyle changes are often the first method used to lower blood pressure. Options are:
People who are not helped by lifestyle changes may need medicine. Options are:
- Diuretics to decrease the amount of fluid in the blood
- Beta blockers to decrease heartbeat force and rate
Medicines that help keep blood vessels from tightening and narrowing, such as:
- Angiotensin converting enzyme (ACE) inhibitors
- Angiotensin receptor blockers
- Calcium channel blockers
- Alpha blockers
- Aldosterone blockers to increase the amount of salt that is lost through urine
American Heart Association
National Heart, Lung, and Blood Institute
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
High blood pressure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/High-Blood-Pressure-or-Hypertension_UCM_002020_SubHomePage.jsp. Accessed February 10, 2021.
Hypertension. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/hypertension. Accessed February 10, 2021.
What is high blood pressure? National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/high-blood-pressure. Accessed February 10, 2021.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018 May 15;71(19):e127.
1/5/2018 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/condition/hypertension: Whelton PK, Carey RM, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017 Nov 13. [Epub ahead of print].
Last reviewed February 2021 by EBSCO Medical Review Board James P. Cornell, MD Last Updated: 2/10/2021