High Blood Pressure

Also known as Hypertension 
High blood pressure is a common disease in which blood flows through blood vessels, or arteries, at higher than normal pressures. Blood pressure is the force of blood pushing against the walls of your arteries as the heart pumps blood. High blood pressure, sometimes called hypertension, is when this force against the artery walls is too high. Your doctor may diagnose you with high blood pressure if you have consistently high blood pressure readings.

To control or lower high blood pressure, your doctor may recommend that you adopt heart-healthy lifestyle changes, such as heart-healthy eating patterns like the DASH eating plan, alone or with medicines. Controlling or lowering blood pressure can also help prevent or delay high blood pressure complications, such as chronic kidney disease, heart attack, heart failure, stroke, and possibly vascular dementia.

Explore this Health Topic to learn more about high blood pressure, our role in research and clinical trials to improve health, and where to find more information.

Causes

Eating too much sodium and having certain medical conditions can cause high blood pressure. Taking certain medicines, including birth control pills or over-the-counter cold relief medicines, can also make blood pressure rise.

Eating too much sodium

Unhealthy eating patterns, particularly eating too much sodium, are a common cause of high blood pressure in the United States. Healthy lifestyle changes, such as heart-healthy eating or the DASH eating plan, can help prevent or treat high blood pressure.

Do you know how sodium causes blood pressure to rise?

Other medical conditions

Other medical conditions change the way your body controls fluids, sodium, and hormones in your blood. Other medical causes of high blood pressure include:

Look for

  • Risk Factors will discuss family history, lifestyle, and other factors that increase your risk of developing high blood pressure.
  • Treatment will discuss heart-healthy lifestyle changes that your doctors may recommend if you are diagnosed with high blood pressure.

Risk Factors

There are many risk factors for high blood pressure. Some risk factors, such as unhealthy lifestyle habits, can be changed. Other risk factors, such as age, family history and genetics, race and ethnicity, and sex, cannot be changed. Heathy lifestyle changes can decrease your risk for developing high blood pressure.

Age

Blood pressure tends to increase with age. Our blood vessels naturally thicken and stiffen over time. These changes increase the risk for high blood pressure.

However, the risk of high blood pressure is increasing for children and teens, possibly due to the rise in the number of children and teens who are living with overweight or obesity.

Want to learn more about the molecular changes that happen in your blood vessels as you age?

Family history and genetics

High blood pressure often runs in families. Much of the understanding of the body systems involved in high blood pressure has come from genetic studies. Research has identified many gene variations associated with small increases in the risk of developing high blood pressure. New research suggests that certain DNA changes during fetal development may also lead to the development of high blood pressure later in life.

Some people have a high sensitivity to sodium. This can also run in families.

Unhealthy lifestyle habits

Unhealthy lifestyle habits can increase the risk of high blood pressure. These habits include:

  • Unhealthy eating patterns, such as eating too much sodium
  • Drinking too much alcohol
  • Being physically inactive

Race or ethnicity

High blood pressure is more common in African American adults than in white, Hispanic, or Asian adults. Compared with other racial or ethnic groups, African Americans tend to have higher average blood pressure numbers and get high blood pressure earlier in life.

Sex

Before age 55, men are more likely than women to develop high blood pressure. After age 55, women are more likely than men to develop high blood pressure.

Screening and Prevention

Everyone age 3 or older should have their blood pressure checked by a healthcare provider at least once a year. Your doctor will use a blood pressure test to see if you have consistently high blood pressure readings. Even small increases in systolic blood pressure can weaken and damage your blood vessels. Your doctor will recommend heart-healthy lifestyle changes to help control your blood pressure and prevent you from developing high blood pressure.

Screening for consistently high blood pressure readings

Your doctor will use a blood pressure test to see if you have higher than normal blood pressure readings. The reading is made up of two numbers, with the systolic number above the diastolic number. These numbers are measures of pressure in millimeters of mercury (mm Hg).

Your blood pressure is considered high when you have consistent systolic readings of 140 mm Hg or higher or diastolic readings of 90 mm Hg or higher. Based on research, your doctor may also consider you to have high blood pressure if you are an adult or child age 13 or older who has consistent systolic readings of 130 to 139 mm Hg or diastolic readings of 80 to 89 mm Hg and you have other cardiovascular risk factors.

For children younger than 13, blood pressure readings are compared to readings common for children of the same, age, sex, and height. Read more about blood pressure readings for children.

Talk to your doctor if your blood pressure readings are consistently higher than normal. Note that readings above 180 over 120 mm Hg are dangerously high and require immediate medical attention.

A blood pressure test is easy and painless and can be done in a doctor's office or clinic. A healthcare provider will use a gauge, stethoscope, or electronic sensor and a blood pressure cuff to measure your blood pressure. To prepare, take the following steps:

  • Do not exercise, drink coffee, or smoke cigarettes for 30 minutes before the test.
  • Go to the bathroom before the test.
  • For at least 5 minutes before the test, sit in a chair and relax.
  • Make sure your feet are flat on the floor.
  • Do not talk while you are relaxing or during the test.
  • Uncover your arm for the cuff.
  • Rest your arm on a table so it is supported and at the level of your heart.

If it is the first time your provider has measured your blood pressure, you may have readings taken on both arms.

Even after taking these steps, your blood pressure reading may not be accurate for other reasons.

  • You are excited or nervous. The phrase “white coat hypertension” refers to blood pressure readings that are only high when taken in a doctor’s office compared with readings taken in other places. Doctors can detect this type of high blood pressure by reviewing readings from the office and from other places.
  • If your blood pressure tends to be lower when measured at the doctor’s office. This is called masked high blood pressure. When this happens, your doctor will have difficulty detecting high blood pressure.
  • The wrong blood pressure cuff was used. Your readings can appear different if the cuff is too small or too large. It is important for your healthcare team to track your readings over time and ensure the correct pressure cuff is used for your sex and age.

Your doctor may run additional tests to confirm an initial reading. To gather more information about your blood pressure, your doctor may recommend wearing a blood pressure monitor to record readings over 24 hours. Your doctor may also teach you how to take blood pressure readings at home.

Healthy lifestyle changes to prevent high blood pressure

Healthy lifestyle changes can help prevent high blood pressure from developing. Healthy lifestyle changes include choosing a heart-healthy eating patterns such as the DASH eating plan, being physically active, aiming for a healthy weight, quitting smoking, and managing stress.

Look for

  • Diagnosis will discuss tests and procedures that your doctor may use to diagnose high blood pressure.
  • Living With will explain what your doctor may recommend to prevent high blood pressure from recurring, getting worse, or causing complications.
  • Research for Your Health will discuss how we are using current research and advancing research to prevent high blood pressure.

Signs, Symptoms, and Complications

It is important to have regular blood pressure readings taken and to know your numbers, because high blood pressure usually does not cause symptoms until serious complications occur. Undiagnosed or uncontrolled high blood pressure can cause the following complications:

Diagnosis

Your doctor may diagnose you with high blood pressure based on your medical history and if your blood pressure readings are consistently at high levels. Diagnoses for children younger than 13 are based on typical readings for their sex, height, and age.

Confirming high blood pressure

To diagnose high blood pressure, your doctor will take two or more readings at separate medical appointments. Learn more about screening for high blood pressure, including how to prepare.

Your doctor may diagnose you with high blood pressure when you have consistent systolic readings of 140 mm Hg or higher or diastolic readings of 90 mm Hg or higher. Based on research, your doctor may also consider you to have high blood pressure if you are an adult or child age 13 or older who has consistent systolic readings of 130 to 139 mm Hg or diastolic readings of 80 to 89 mm Hg and you have other cardiovascular risk factors.

For children younger than 13, blood pressure readings are compared to readings common for children of the same, age, sex, and height. Read more about blood pressure readings for children.

Talk to your doctor if your blood pressure readings are consistently higher than normal. Note that readings above 180 over 120 mm Hg are dangerously high and require immediate medical attention.

Your doctor may diagnose you with one of two types of high blood pressure. What is the difference?

Medical history

Your doctor will want to understand your risk factors, general information about your health—such as your eating patterns, your physical activity levels, and your family’s health history. This information can help your doctor develop a treatment plan.

Tests to identify other medical conditions

Your doctor may order additional tests to see if another condition or medicine is causing your high blood pressure. Doctors can use this information to develop your treatment plan.

Reminders

Treatment

For most people with high blood pressure, a doctor will develop a treatment plan that may include heart-healthy lifestyle changes alone or with medicines. Heart-healthy lifestyle changes, such as heart-healthy eating, can be highly effective in treating high blood pressure.

If your high blood pressure is caused by another medical condition or medicine, it may improve once the cause is treated or removed.

Healthy lifestyle changes

If you have high blood pressure, your doctor may recommend that you adopt lifelong heart-healthy lifestyle changes to help lower and control high blood pressure. These include:

  • Heart-healthy eating patterns such as the DASH eating plan. NHLBI-funded research has shown that DASH combined with a low-salt eating plan can be as effective as medicines in lowering high blood pressure. Learn more about the blood pressure lowering effects and other health benefits of the DASH eating plan.
  • Being physically active. Many health benefits result from being physically active and getting the recommended amount of physical activity each week. Studies have shown that physical activity can help lower and control high blood pressure levels. Before starting any exercise program, ask your doctor what level of physical activity is right for you.
  • Aiming for a healthy weight. If you are an adult who is living with overweight or obesity, losing 5 to 10 percent of your initial weight over about six months can improve your health. Even losing just 3 to 5 percent of your weight can improve blood pressure readings.
  • Quitting smoking. Visit Smoking and Your Heart and the National Heart, Lung, and Blood Institute’s Your Guide to a Healthy Heart [PDF – 2MB]. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
  • Managing stress.

To help make lifelong heart-healthy lifestyle changes, try making one change at a time and add another change when you feel that you have successfully adopted the earlier changes. When you practice several healthy lifestyle habits, you are more likely to lower or control your high blood pressure and maintain normal blood pressure.

Medicines

When healthy lifestyle changes alone do not control or lower high blood pressure, your doctor may change or update your treatment plan by prescribing medicines to treat your condition. These medicines act in different ways to lower blood pressure. When prescribing medicines, your doctor will also consider their effect on other conditions you might have, such as heart disease or kidney disease. Possible high blood pressure medicines include:

  • Angiotensin-converting enzyme (ACE) inhibitors: Block the production of the angiotensin II hormone, one part of the basic system the body uses to control blood pressure. When angiotensin II is blocked, the blood vessels do not narrow.
  • Angiotensin II receptor blockers (ARBs): Block angiotensin II hormone from binding with receptors in the blood vessels. ARBs work the same way as ACE inhibitors to keep blood vessels from narrowing.
  • Calcium channel blockers: Keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax.
  • Diuretics (water or fluid pills): Flush excess sodium from your body, reducing the amount of fluid in your blood. The main diuretic for high blood pressure treatment is thiazide. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill.

If your doctor prescribes medicines as a part of your treatment plan, keep up your healthy lifestyle changes. The combination of the medicines and the heart-healthy lifestyle changes can help control and lower your high blood pressure and prevent heart disease.

If you have concerns about any side effects from your medicine, talk with your doctor to see if he or she can change the dose or prescribe a new medicine.

What should I know about high blood pressure medicines in children, women, and African Americans?

Look for

  • Research for Your Health will explain how we are using current research and advancing research to treat people with high blood pressure.
  • Participate in NHLBI Clinical Trials will discuss our ongoing clinical studies that are investigating treatments for high blood pressure.
  • Living With will explain what your doctor may recommend, including lifelong heart-healthy lifestyle changes and medical care to prevent high blood pressure from getting worse or causing complications.

Living With

If you have been diagnosed with high blood pressure, it is important that you continue your treatment plan. Following your treatment plan, getting regular follow-up care, and learning how to monitor your condition at home are important. Let your doctor know if you are planning to become pregnant. These steps can help prevent or delay complications that high blood pressure can cause. Your doctor may adjust your treatment plan as needed to lower or control your high blood pressure.

Receive routine follow-up care

Check your blood pressure and have regular medical checkups or tests as your doctor advises. Your doctor may suggest ways for you to monitor your blood pressure at home. During checkups, talk to your doctor about these important topics:

  • Blood pressure readings
  • Your overall health
  • Your treatment plan

Your doctor may need to change or add medicines to your treatment plan over time. To help control your blood pressure and prevent heart disease, keep up your healthy lifestyle changes. You can ask questions and discuss your progress as part of your follow-up.

Return to Treatment to review possible treatment options for your high blood pressure.

Monitor your condition yourself

Your doctor may ask you to check readings at home or at other locations that have blood pressure equipment. You may be able to send readings to your doctor’s office electronically, or you can keep a written log [PDF, 663K] of all your results.

Keeping track of your blood pressure is important. Your doctor can help you learn how to check your blood pressure at home. Each time you check your own blood pressure, record your numbers and the date. Send or take the log of your blood pressure readings with you for appointments with your doctor. Return to Screening for reminders on how to prepare for blood pressure testing.

Pregnancy planning

High blood pressure can cause problems for a mother and her baby. High blood pressure can harm a mother’s kidneys and other organs and can cause early birth and low birth weight. If you are thinking about having a baby and have high blood pressure, talk with your doctors so you can take steps to lower or control your high blood pressure before and during the pregnancy.

Some medicines used to treat high blood pressure are not recommended during pregnancy. If you are taking medicines to lower or control your high blood pressure, talk with your doctor about your choices for safely managing high blood pressure during pregnancy.

Some women with normal blood pressure develop high blood pressure during pregnancy. As part of your regular prenatal care, your doctor will measure your blood pressure at each visit. If you develop high blood pressure, your doctor will closely monitor you and your baby and provide special care to lower the chance of complications. With such care, most women and babies have good outcomes.

Prevent worsening high blood pressure or complications over your lifetime

If you have high blood pressure, it is important to get routine medical care and to follow your prescribed treatment plan, which will include heart-healthy lifestyle changes and possibly medicines. Heart-healthy lifestyle changes can prevent high blood pressure, reduce elevated blood pressure, help control existing high blood pressure, and prevent complications, such as heart attack, heart failure, stroke, vascular dementia, or chronic kidney disease.

Learn the warning signs of serious complications and have a plan

High blood pressure can lead to serious complications such as heart attack or stroke. Call 911 if you suspect any of the following in you or someone else:

  • Heart attack. Signs of heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. Women may also have chest pain and pain down the left arm, but they are more likely to have less typical symptoms, such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.
  • Stroke. If you think someone may be having a stroke, act F.A.S.T. and perform the following simple test:
    • F—Face: Ask the person to smile. Does one side of the face droop?
    • A—Arms: Ask the person to raise both arms. Does one arm drift downward?
    • S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
    • T—Time: If you observe any of these signs, call for help immediately. Early treatment is essential.
    Read more about the signs and symptoms of a stroke.
  • Dangerously high blood pressure. Readings above 180 over 120 are dangerously high and require immediate medical attention.
Research for Your Health

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including high blood pressure. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.

Improving health with current research

Learn about the following ways in which the NHLBI continues to translate current research and science into improved health for people with high blood pressure. Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery.

  • Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). This NHLBI study began in 1994 and lasted eight years. People with high blood pressure enrolled in one part of the study and people with high blood cholesterol enrolled in another part of the study. ALLHAT’s findings have informed how we treat high blood pressure and high blood cholesterol. Visit Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial for more information about all research activities and advances from this study.
  • NHLBI Expert Panel on Cardiovascular Health and Risk Reduction in Children and Adolescents. We have supported the development of guidelines based on up-to-date research to evaluate and manage risk of heart disease in children and adolescents, including high blood pressure. Visit Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents for more information.
  • NHLBI-funded Research Supports Development of Guidelines for High Blood Pressure Management. To date, our Systolic Blood PRessure INtervention Trial (SPRINT) is the largest study of its kind to examine how maintaining systolic blood pressure at a lower level than previously recommended level would affect heart and vascular diseases. Visit the SPRINT Overview for more information about the health benefits of a more intensive high blood pressure treatment and how SPRINT findings helped shaped the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, published in the Journal of American College of Cardiology and Hypertension.

Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.

Advancing research for improved health

In support of our mission, we are committed to advancing high blood pressure research in part through the following ways.

Learn about exciting high blood pressure research that the NHLBI is exploring.

Participate in NHLBI Clinical Trials

We lead or sponsor many studies relevant to high blood pressure. See if you or someone you know is eligible to participate in our clinical trials.

Are you an adult who seeks treatment for high blood pressure in the emergency room?

This study is assessing techniques to help patients who have high blood pressure follow their treatment plan and decrease their visits to the emergency department. To participate, you must be between 21 and 85 years old. Please note that this study is in Nashville, Tennessee.

Are you an adult who is curious about how sodium affects your blood pressure?

This study is testing if limiting sodium can affect individuals with a specific genetic predisposition to high blood pressure. To participate you must be 18 years old or older and not have high blood pressure. Please note that this study is in Charlottesville, Virginia.

Are you an adult whose high blood pressure does not improve with lifestyle changes and medicines?

This study will assess whether minocycline, an antibiotic with anti-inflammatory effects, can improve blood pressure control in patients who do not respond to medicines in combination with lifestyle changes, such as physical activity, weight loss, and healthy eating patterns. To participate you must be at least 18 years old and have high blood pressure that does not respond to treatment with three different high blood pressure medicines even when used at the maximum doses. Please note that this study is in Gainesville, Florida.

Are you an adult with high blood pressure who prefers natural therapies?

This study is investigating whether modified citrus pectin, a dietary supplement derived from plants, can decrease heart failure and other complications of high blood pressure. To participate patients must be at least 21 years old and have an established treatment plan for high blood pressure. Please note that this study is in Boston, Massachusetts.

Are you an African American adult living in the Washington, D.C. metro area?

This study is assessing the association between DNA, health behaviors, social and environmental factors, and risk factors of heart disease, such as high blood pressure, in African Americans. To participate you must be an African American between 21 and 65 years old, living in Washington, D.C., or Montgomery or Prince Georges counties in Maryland. Please note that this study is being conducted in Bethesda, Maryland.

Are you an adult who has insomnia and high blood pressure?

This study is evaluating three different behavioral interventions for treatment of insomnia and the effects of insomnia on blood pressure. To participate, you must be at least 18 years old and have insomnia and high blood pressure. Please note that this study is in Pittsburgh, Pennsylvania.

Are you an adult whose high blood pressure has not improved with medicines?

This study is assessing whether a low-sodium and low-calorie eating pattern, along with aerobic exercise, can improve blood pressure in patients who do not respond to high blood pressure medicines. To participate you must be at least 35 years and have high blood pressure that does not respond to medicines. Please note that this study is in Durham, North Carolina.

Do you know a child, teen, or young adult with sickle cell disease and high blood pressure?

This study is evaluating a possible treatment for patients with sickle cell disease and high blood pressure to prevent kidney damage. To participate, you must be between 5 and 25 years old and have sickle cell disease and high blood pressure. Please note that this study is in Birmingham, Alabama.
View more information about Preventing Sickle Cell Kidney Disease.
More Information

After reading our High Blood Pressure Health Topic, you may be interested in additional information found in the following resources.

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