High blood pressure (hypertension)

To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

Blood pressure measurements fall into four general categories:

•  Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
•  Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time.
•  Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.
• Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

Both numbers in a blood pressure reading are important. But after age 60, the systolic reading is even more significant. Isolated systolic hypertension — when diastolic pressure is normal but systolic pressure is high — is a common type of high blood pressure among people older than 60.

Your doctor will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and sometimes specifically during visits to the doctor, a condition called white-coat hypertension. Your blood pressure should be measured in both arms to determine if there is a difference. Your doctor may ask you to record your blood pressure at home and at work to provide additional information.

If you have any type of high blood pressure, your doctor will review your medical history and conduct a physical examination.

Your doctor may also recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram — a test that measures your heart's electrical activity. Your doctor may also recommend additional tests, such as a cholesterol test, to check for more signs of heart disease.

Taking your blood pressure at home

 

An important way to check if your blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home. Home blood pressure monitors are widely available, and you don't need a prescription to buy one. Talk to your doctor about how to get started.

Changing your lifestyle can go a long way toward controlling high blood pressure. Your doctor may recommend you eat a healthy diet with less salt, exercise regularly, quit smoking and maintain a healthy weight. But sometimes lifestyle changes aren't enough.

In addition to lifestyle changes, your doctor may recommend medication to lower your blood pressure.

Your blood pressure treatment goal depends on how healthy you are.

Blood pressure treatment goals*

*Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.
Less than150/90 mm Hg	If you're a healthy adult age 60 or older
Less than140/90 mm Hg	If you're a healthy adult younger than age 60
Less than140/90 mm Hg	If you have chronic kidney disease, diabetes or coronary artery disease or are at high risk of coronary artery disease

If you're age 60 or older, and use of medications results in lower systolic blood pressure (such as less than 140 mm Hg), your medications won't need to be changed unless they cause negative effects to your health or quality of life.

Also, people older than 60 commonly have isolated systolic hypertension — when diastolic pressure is normal but systolic pressure is high.

The category of medication your doctor prescribes depends on your blood pressure measurements and whether you also have other medical problems.

Medications to treat high blood pressure

 

•  

  Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume.

  Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may work better for blacks than do angiotensin-converting enzyme (ACE) inhibitors alone.

•  

  Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force.

  When prescribed alone, beta blockers don't work as well, especially in older adults, but may be effective when combined with other blood pressure medications.

•  
Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from ACE inhibitors as one of their medications.
•  
• Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from ARBs as one of their medications.
•  Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and blacks than do ACE inhibitors alone.
  Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions.
•  Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure.
  Tekturna works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.

If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

•  Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
•  Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
•  Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
•  Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
•  Aldosterone antagonists. Examples are spironolactone (Aldactone) and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.

No matter what medications your doctor prescribes to treat your high blood pressure, you'll need to make lifestyle changes to lower your blood pressure.

Your doctor may recommend several lifestyle changes, including:

•  Eating a healthier diet with less salt (the Dietary Approaches to Stop Hypertension, or DASH, diet)
•  Exercising regularly
•  Quitting smoking
•  Losing weight

If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension.

Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.

Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective.

Your doctor or hypertension specialist can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses.

In addition, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.

If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medication, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't change your treatment without your doctor's guidance.

Lifestyle changes can help you control and prevent high blood pressure, even if you're taking blood pressure medication. Here's what you can do:

•  Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat.
•  

  Decrease the salt in your diet. A lower sodium level — 1,500 milligrams (mg) a day — is appropriate for people 51 years of age or older, and individuals of any age who are African-American or who have hypertension, diabetes or chronic kidney disease.

  Otherwise healthy people can aim for 2,300 mg a day or less. While you can reduce the amount of salt you eat by putting down the saltshaker, you should also pay attention to the amount of salt that's in the processed foods you eat, such as canned soups or frozen dinners.

•  Maintain a healthy weight. If you're overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure.
•  Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.
•  Limit alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
•  Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your doctor to help you quit.
•  Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too.
•  

  Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications.

  If your blood pressure is under control, you may be able to make fewer visits to your doctor if you monitor your blood pressure at home.

•  

  Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. There are some devices available that can help guide your breathing for relaxation. However, it's questionable whether these devices have a significant effect on lowering your blood pressure.

Although diet and exercise are the most appropriate tactics to lower your blood pressure, some supplements also may help lower it. However, more research is needed. These include:

•  Fiber, such as blond psyllium and wheat bran
•  Minerals, such as calcium and potassium
•  Supplements that increase nitric oxide or widen blood vessels (vasodilators), such as cocoa, Coenzyme Q10 or garlic
•  Omega-3 fatty acids, found in fatty fish, fish oil supplements or flaxseed
•  Probiotics, found in fermented dairy products such as cultured yogurt, buttermilk, acidophilus milk, cultured sour cream and cheese

While it's best to include these supplements in your diet as foods, you can also take supplement pills or capsules. Probiotic supplements, however, have been studied in a limited number of trials, and conclusions haven't been made regarding their potential effect on blood pressure. Talk to your doctor before adding any of these supplements to your blood pressure treatment. Some supplements can interact with medications, causing harmful side effects, such as an increased bleeding risk that could be fatal.

You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices may temporarily reduce your blood pressure.

High blood pressure isn't a problem that you can treat and then ignore. It's a condition you need to manage for the rest of your life. To keep your blood pressure under control:

•  Take your medications properly. If side effects or costs pose problems, don't stop taking your medications. Ask your doctor about other options.
•  Schedule regular doctor visits. It takes a team effort to treat high blood pressure successfully. Your doctor can't do it alone, and neither can you. Work with your doctor to bring your blood pressure to a safe level, and keep it there.
•  Adopt healthy habits. Eat healthy foods, lose excess weight and get regular physical activity. Limit alcohol. If you smoke, quit.
•  Manage stress. Say no to extra tasks, release negative thoughts, maintain good relationships, and remain patient and optimistic.

Sticking to lifestyle changes can be difficult, especially if you don't see or feel any symptoms of high blood pressure. If you need motivation, remember the risks associated with uncontrolled high blood pressure. It may help to enlist the support of your family and friends as well.