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High blood pressure - adults

Hypertension; HBP

Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the term used to describe high blood pressure.

Untreated high blood pressure can lead to many medical problems. These include heart disease, stroke, kidney failure, eye problems, and other health issues.

Blood pressure readings are given as two numbers. The top number is called systolic blood pressure. The bottom number is called diastolic blood pressure. For example, 120 over 80 (written as 120/80 mm Hg).

One or both of these numbers can be too high. (Note: These numbers apply to people who are not taking medicines for blood pressure and who are not ill.)

If you have heart or kidney problems, or you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.

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Causes

Many factors can affect blood pressure, including:

You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, or early death.

You have a higher risk of high blood pressure if you:

Most of the time, no cause of high blood pressure is found. This is called essential hypertension.

High blood pressure that is caused by another medical condition or medicine you are taking is called secondary hypertension. Secondary hypertension may be due to:

Symptoms

Most of the time, there are no symptoms. For most people, high blood pressure is found when they visit their health care provider or have it checked elsewhere.

Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure.

Malignant hypertension is a dangerous form of very high blood pressure. Symptoms may include:

Exams and Tests

Diagnosing high blood pressure early can help prevent heart disease, stroke, eye problems, and chronic kidney disease.

Your provider will measure your blood pressure many times before diagnosing you with high blood pressure. It is normal for your blood pressure to be different based on the time of day.

All adults over the age of 18 should have their blood pressure checked every year. More frequent measurement may be needed for those with a history of high blood pressure readings or those with risk factors for high blood pressure.

Blood pressure readings taken at home may be a better measure of your current blood pressure than those taken at your provider's office.

Your provider will do a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body.

Tests may also be done to look for:

Treatment

The goal of treatment is to reduce your blood pressure so that you have a lower risk of health problems caused by high blood pressure. You and your provider should set a blood pressure goal for you.

Whenever thinking about the best treatment for high blood pressure, you and your provider must consider other factors such as:

If your blood pressure is between 120/80 and 130/80 mm Hg, you have elevated blood pressure.

If your blood pressure is higher than 130/80, but lower than 140/90 mm Hg, you have Stage 1 high blood pressure. When thinking about the best treatment, you and your provider must consider:

If your blood pressure is higher than 140/90 mm Hg, you have Stage 2 high blood pressure. Your provider will most likely start you on medicines and recommend lifestyle changes.

Before making a final diagnosis of either elevated blood pressure or high blood pressure, your provider should ask you to have your blood pressure measured at home, at your pharmacy, or somewhere else besides their office or a hospital.

LIFESTYLE CHANGES

You can do many things to help control your blood pressure, including:

Your provider can help you find programs for losing weight, stopping smoking, and exercising.

You can also get a referral to a dietitian, who can help you plan a diet that is healthy for you.

How low your blood pressure should be and at what level you need to start treatment is individualized, based on your age and any medical problems you have.

MEDICINES FOR HYPERTENSION

Most of the time, your provider will try lifestyle changes first, and check your blood pressure two or more times. Medicines will likely be started if your blood pressure readings remain at or above these levels:

If you have diabetes, heart problems, or a history of a stroke, medicines may be started at lower blood pressure reading. The most commonly used blood pressure targets for people with these medical problems are below 120 to 130/80 mm Hg.

There are many different medicines to treat high blood pressure.

Outlook (Prognosis)

Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.

When blood pressure is not well-controlled, you are at risk for:

When to Contact a Medical Professional

If you have high blood pressure, you will have regular checkups with your provider.

Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your regular check-up, especially if someone in your family has or had high blood pressure.

Call your provider right away if home monitoring shows that your blood pressure is still high.

Prevention

Most people can prevent high blood pressure from occurring by following lifestyle changes designed to bring blood pressure down.

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References

American Diabetes Association. 9. Cardiovascular disease and risk management: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S86-S104. PMID: 29222380 www.ncbi.nlm.nih.gov/pubmed/29222380.

James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. PMID: 24352797 www.ncbi.nlm.nih.gov/pubmed/24352797.

Meschia JF, Bushnell C, Boden-Albala B, et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754-3832. PMID: 25355838 www.ncbi.nlm.nih.gov/pubmed/25355838.

Palmer SC, Mavridis D, Navarese E, et al. Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: a network meta-analysis. Lancet. 2015;385(9982):2047-2056. PMID: 26009228 www.ncbi.nlm.nih.gov/pubmed/26009228.

Siu AL; US Preventive Services Task Force. Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(10):778-786. PMID: 26458123 www.ncbi.nlm.nih.gov/pubmed/26458123.

Victor RG. Systemic hypertension: mechanisms and diagnosis. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 46.

Victor RG, Libby P. Systemic hypertension: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 47.

Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich). 2014;16(1):14-26. PMID: 24341872 www.ncbi.nlm.nih.gov/pubmed/24341872.

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;71(19):e127-e248. PMID: 29146535 www.ncbi.nlm.nih.gov/pubmed/29146535.

Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387(10017):435-443. PMID: 26559744 www.ncbi.nlm.nih.gov/pubmed/26559744.

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Review Date: 2/22/2018  

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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