ConditionHeart & circulation
High Blood Pressure (Hypertension)
High blood pressure, or hypertension, is blood pressure that stays at or above 130/80 mm Hg. It affects nearly half of US adults and usually causes no symptoms, yet over years it damages arteries and raises the risk of heart attack, stroke, heart failure, kidney disease and dementia. It is diagnosed with repeated readings, ideally including home monitoring. Lifestyle changes and, for many people, daily medicine bring it under control.
Also called: Hypertension, HTN, raised blood pressure, the silent killer
At a glance
- Definition
- Repeated readings of 130/80 mm Hg or higher (stage 1); 140/90 or higher is stage 2.
- How common
- Nearly half of US adults; many do not know they have it.
- Symptoms
- Usually none.
- Causes
- Mostly age, genes, weight, salt, alcohol and inactivity; about 1 in 10 has a specific secondary cause.
- Treatment
- DASH-style diet, less salt, exercise, weight loss, less alcohol, and medicines.
- Target
- For most adults, below 130/80 if it can be reached safely.
When to get help
Call 911 or go to the ER
- Blood pressure over 180/120 with chest pain, shortness of breath, severe headache, confusion, weakness or numbness, trouble speaking, or vision loss
- Pregnant or recently given birth, with a severe headache, vision changes, upper belly pain or breathlessness
See a doctor within a day or two
- Blood pressure over 180/120 on repeat checks without symptoms
- Pregnant or postpartum with readings of 140/90 or higher
- Swollen ankles, breathlessness lying flat, or reduced urine with high blood pressure
- Dizziness or fainting after starting or increasing blood pressure medicine
Book a routine appointment
- Home average of 130/80 or higher, or elevated readings at two or more visits
- Blood pressure still above target after a month on treatment
- High blood pressure starting before age 30, or with low potassium, or needing three or more medicines
Usually safe to manage at home
- Elevated readings (120 to 129 systolic) with no other risk factors: lifestyle changes and regular rechecks
What high blood pressure is
Blood pressure is the force of blood against artery walls. It rises and falls throughout the day. Hypertension means it stays high most of the time. That constant extra pressure stiffens and thickens the arteries, speeds up the buildup of fatty plaque (atherosclerosis), and makes the heart work harder.
Blood pressure stages
| Category | Systolic (top) | Diastolic (bottom) | |
|---|---|---|---|
| Normal | Under 120 | and | Under 80 |
| Elevated | 120 to 129 | and | Under 80 |
| Stage 1 hypertension | 130 to 139 | or | 80 to 89 |
| Stage 2 hypertension | 140 or higher | or | 90 or higher |
| Hypertensive crisis | Over 180 | and/or | Over 120 |
Some countries, including the UK, use 140/90 as the threshold for diagnosis. If you have one high reading and want to know what to do now, see high blood pressure reading.
Symptoms
Most people have no symptoms at all. That is why hypertension is called the silent killer and why adults should have blood pressure checked at least every 1 to 2 years, and yearly from age 40 or with risk factors.
Symptoms appear mainly in a hypertensive crisis or once organs are damaged: severe headache, chest pain, breathlessness, vision changes, confusion, or stroke symptoms.
Causes and risk factors
Primary (essential) hypertension
About 9 in 10 cases have no single cause. It develops over years from a combination of:
- Age: arteries stiffen; systolic pressure rises with age
- Family history and genetics
- Race: higher rates and earlier onset in Black Americans
- Excess weight: especially around the waist
- High salt intake and low potassium intake
- Physical inactivity
- Alcohol: more than 1 drink a day for women or 2 for men
- Smoking and vaping
- Stress and poor sleep
- Diabetes and high cholesterol, which often occur together
Secondary hypertension
A specific, sometimes curable cause is more likely if hypertension is severe, starts suddenly, starts young, or resists three medicines:
- chronic kidney disease
- primary aldosteronism (an adrenal hormone excess, often with low potassium)
- obstructive sleep apnea
- renal artery narrowing
- thyroid disease, Cushing syndrome, pheochromocytoma
- coarctation of the aorta (in young people)
- medicines: NSAIDs, decongestants, birth control pills with estrogen, steroids, some antidepressants, stimulants
- recreational drugs such as cocaine and amphetamines
High blood pressure in pregnancy
Pregnancy can bring gestational hypertension or preeclampsia, which affects the mother's organs and the baby's growth. See hypertension of pregnancy.
Diagnosis
- Accurate office readings: seated, rested 5 minutes, correct cuff size, averaged over 2 or more readings at 2 or more visits.
- Out-of-office readings: home monitoring or 24-hour ambulatory monitoring confirms the diagnosis and detects white coat hypertension (high only in the clinic) and masked hypertension (normal in the clinic, high at home).
- Baseline tests: blood sugar, cholesterol, kidney function, potassium and sodium, urine test for protein, thyroid test, and an ECG.
- Risk assessment: your 10-year risk of heart disease and stroke helps decide when to start medicines.
- Further tests for secondary causes when suspected.
Treatment
Lifestyle changes
Each change lowers systolic pressure by a few points. Together, the effect is often as large as a medicine.
| Change | Typical systolic reduction |
|---|---|
| DASH diet (vegetables, fruit, whole grains, low-fat dairy, less saturated fat) | About 11 mm Hg in people with hypertension |
| Cutting sodium, ideally under 1,500 mg a day, or by at least 1,000 mg | About 5 to 6 mm Hg |
| Losing weight | About 1 mm Hg per kg (2.2 lb) lost |
| Aerobic exercise, 90 to 150 minutes a week | About 5 to 8 mm Hg |
| Limiting alcohol | About 4 mm Hg |
| More potassium from food (unless you have kidney disease) | About 4 to 5 mm Hg |
Most dietary sodium comes from processed and restaurant food, not the salt shaker. Breads, cured meats, pizza, soups and sandwiches are major sources.
Medicines
Medicines are recommended when blood pressure is 140/90 or higher, or 130/80 or higher in people with heart disease, diabetes, kidney disease or high cardiovascular risk. Main classes:
- Thiazide-type diuretics (chlorthalidone, hydrochlorothiazide)
- ACE inhibitors (lisinopril, ramipril): can cause a dry cough
- Angiotensin receptor blockers (losartan, valsartan)
- Calcium channel blockers (amlodipine): can cause ankle swelling
- Beta-blockers: used mainly when there is also heart disease or atrial fibrillation
- Spironolactone: for resistant hypertension
Many people need two or more medicines, often combined in a single pill. ACE inhibitors and ARBs are not used in pregnancy.
Tips for taking medicine
- Take it every day, even when you feel well.
- Do not stop suddenly, especially beta-blockers and clonidine.
- Avoid NSAIDs and decongestants where possible, as they raise blood pressure.
- Get kidney function and potassium checked after starting ACE inhibitors, ARBs or diuretics.
- Stand up slowly at first if you feel lightheaded.
Complications
Uncontrolled hypertension is a leading cause of:
- stroke and vascular dementia
- heart attack and coronary artery disease
- heart failure and thickened heart muscle
- atrial fibrillation
- chronic kidney disease
- aortic aneurysm and dissection
- peripheral artery disease
- retinal damage and vision loss
- erectile dysfunction
Each 20 mm Hg rise in systolic pressure above 115 roughly doubles the risk of dying from heart disease or stroke.
Outlook
Hypertension is usually lifelong, but it is one of the most treatable cardiovascular risk factors. Bringing blood pressure to target sharply reduces the risk of stroke and heart failure. Some people who lose a lot of weight or make major changes can reduce or stop medicines under supervision.
Frequently asked questions
What is considered high blood pressure?
In the US, high blood pressure is a consistent reading of 130/80 mm Hg or higher. Stage 2 is 140/90 or higher. A reading over 180/120 is a hypertensive crisis. Diagnosis is based on repeated readings, preferably including home measurements.
What causes high blood pressure?
Most cases have no single cause and result from age, genes, excess weight, high salt intake, alcohol, inactivity, smoking and stress. About 1 in 10 cases is caused by another condition, such as kidney disease, sleep apnea, hormone disorders or certain medicines.
Can high blood pressure be cured?
Primary hypertension usually cannot be cured, but it can be controlled. Secondary hypertension can sometimes be cured by treating the cause, such as removing an adrenal tumor. Weight loss and lifestyle change can bring some people back to normal without medicine.
What is the fastest way to lower blood pressure naturally?
There is no safe quick fix. The most effective natural measures are reducing sodium, following the DASH diet, regular aerobic exercise, weight loss and cutting alcohol. Effects build over 2 to 4 weeks. Do not stop prescribed medicine without talking to your doctor.
Do I have to take blood pressure medicine for life?
Often, yes, because high blood pressure is usually a long-term condition. Some people can reduce or stop medicines after major weight loss or lifestyle change, but only under medical supervision with regular monitoring, as pressure often rises again.
What blood pressure should I aim for?
For most adults on treatment, the target is below 130/80 mm Hg if it can be achieved without side effects such as dizziness. Your doctor may set a different target based on age, frailty, kidney disease or pregnancy.
Sources
This guide was written from current patient and clinical guidance, including:
- ACC/AHA: Guideline for the prevention, detection, evaluation and management of high blood pressure in adults
- CDC: High blood pressure facts
- American Heart Association: Understanding blood pressure readings
- NHLBI: High blood pressure
- NIH: DASH eating plan