Hypertension, Adult

High blood pressure (hypertension) is when the force of blood pumping through the arteries is too strong. The arteries are the blood vessels that carry blood from the heart throughout the body. Hypertension forces the heart to work harder to pump blood and may cause arteries to become narrow or stiff. Untreated or uncontrolled hypertension can lead to a heart attack, heart failure, a stroke, kidney disease, and other problems.

A blood pressure reading consists of a higher number over a lower number. Ideally, your blood pressure should be below 120/80. The first ("top") number is called the systolic pressure. It is a measure of the pressure in your arteries as your heart beats. The second ("bottom") number is called the diastolic pressure. It is a measure of the pressure in your arteries as the heart relaxes.

What are the causes?

The exact cause of this condition is not known. There are some conditions that result in high blood pressure.

What increases the risk?

• Smoking.
• Not getting enough exercise or physical activity.
• Being overweight.
• Having too much fat, sugar, calories, or salt (sodium) in your diet.
• Drinking too much alcohol.

• Having a personal history of heart disease, diabetes, high cholesterol, or kidney disease.
• Stress.
• Having a family history of high blood pressure and high cholesterol.
• Having obstructive sleep apnea.
• Age. The risk increases with age.

What are the signs or symptoms?

• Headache.
• Fast or irregular heartbeats (palpitations).
• Shortness of breath.
• Nosebleed.
• Nausea and vomiting.
• Vision changes.
• Severe chest pain, dizziness, and seizures.

How is this diagnosed?

This condition is diagnosed by measuring your blood pressure while you are seated, with your arm resting on a flat surface, your legs uncrossed, and your feet flat on the floor. The cuff of the blood pressure monitor will be placed directly against the skin of your upper arm at the level of your heart. Blood pressure should be measured at least twice using the same arm. Certain conditions can cause a difference in blood pressure between your right and left arms.

• Return on a different day to have your blood pressure checked again.
• Monitor your blood pressure at home for 1 week or longer.

If you are diagnosed with hypertension, you may have other blood or imaging tests to help your health care provider understand your overall risk for other conditions.

How is this treated?

This condition is treated by making healthy lifestyle changes, such as eating healthy foods, exercising more, and reducing your alcohol intake. You may be referred for counseling on a healthy diet and physical activity.

• Your systolic blood pressure is above 130.
• Your diastolic blood pressure is above 80.

Your personal target blood pressure may vary depending on your medical conditions, your age, and other factors.

Follow these instructions at home:

Eating and drinking

• Eat a diet that is high in fiber and potassium, and low in sodium, added sugar, and fat. An example of this eating plan is called the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension. To eat this way:
  • Eat plenty of fresh fruits and vegetables. Try to fill one half of your plate at each meal with fruits and vegetables.
  • Eat whole grains, such as whole-wheat pasta, brown rice, or whole-grain bread. Fill about one fourth of your plate with whole grains.
  • Eat or drink low-fat dairy products, such as skim milk or low-fat yogurt.
  • Avoid fatty cuts of meat, processed or cured meats, and poultry with skin. Fill about one fourth of your plate with lean proteins, such as fish, chicken without skin, beans, eggs, or tofu.
  • Avoid pre-made and processed foods. These tend to be higher in sodium, added sugar, and fat.
• Reduce your daily sodium intake. Many people with hypertension should eat less than 1,500 mg of sodium a day.
• Do not drink alcohol if:
  • Your health care provider tells you not to drink.
  • You are pregnant, may be pregnant, or are planning to become pregnant.
• If you drink alcohol:
  • Limit how much you have to:
    • 0–1 drink a day for women.
    • 0–2 drinks a day for men.
  • Know how much alcohol is in your drink. In the U.S., one drink equals one 12 oz bottle of beer (355 mL), one 5 oz glass of wine (148 mL), or one 1½ oz glass of hard liquor (44 mL).

Lifestyle

• Work with your health care provider to maintain a healthy body weight or to lose weight. Ask what an ideal weight is for you.
• Get at least 30 minutes of exercise that causes your heart to beat faster (aerobic exercise) most days of the week. Activities may include walking, swimming, or biking.
• Include exercise to strengthen your muscles (resistance exercise), such as Pilates or lifting weights, as part of your weekly exercise routine. Try to do these types of exercises for 30 minutes at least 3 days a week.
• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Monitor your blood pressure at home as told by your health care provider.
• Keep all follow-up visits. This is important.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider. Follow directions carefully. Blood pressure medicines must be taken as prescribed.
• Do not skip doses of blood pressure medicine. Doing this puts you at risk for problems and can make the medicine less effective.
• Ask your health care provider about side effects or reactions to medicines that you should watch for.

Contact a health care provider if you:

• Think you are having a reaction to a medicine you are taking.
• Have headaches that keep coming back (recurring).
• Feel dizzy.
• Have swelling in your ankles.
• Have trouble with your vision.

Get help right away if you:

• Develop a severe headache or confusion.
• Have unusual weakness or numbness.
• Feel faint.
• Have severe pain in your chest or abdomen.
• Vomit repeatedly.
• Have trouble breathing.

• Do not wait to see if the symptoms will go away.
• Do not drive yourself to the hospital.

Summary

• Hypertension is when the force of blood pumping through your arteries is too strong. If this condition is not controlled, it may put you at risk for serious complications.
• Your personal target blood pressure may vary depending on your medical conditions, your age, and other factors. For most people, a normal blood pressure is less than 120/80.
• Hypertension is treated with lifestyle changes, medicines, or a combination of both. Lifestyle changes include losing weight, eating a healthy, low-sodium diet, exercising more, and limiting alcohol.