What is high blood pressure?
Blood pressure is a way to measure the flow of blood throughout the vessels of the body. A normal blood pressure keeps the heart pumping efficiently so it can deliver oxygen to the rest of your body. This process can be disrupted if blood pressure is too high or too low.
High blood pressure, or hypertension, is the most common medical reason for doctors’ visits and prescriptions in the U.S. Almost half of American adults have elevated blood pressure, according to a study in the journal Circulation.
What is considered high blood pressure vs. borderline
A normal blood pressure (BP) is less than 120/80 mmHg. The first number is your systolic blood pressure, which is the pressure the blood puts on the vessel walls when the heart beats. The second number is your diastolic blood pressure, which is the pressure the blood puts on the vessel walls in between heartbeats, or when the heart relaxes.
Hypertension is often asymptomatic until it causes long-term complications to various organs of the body, so the most important thing is to diagnose and treat it early. —Dr. Jay Patel
There are three different levels of high blood pressure:
- Elevated or borderline blood pressure is a systolic BP between 120-129 mmHg and a diastolic BP less than 80 mmHg. Borderline blood pressure doesn’t always require medication. But you should monitor your blood pressure at regular doctor’s visits or at home using a blood pressure cuff.
- Stage I hypertension is a systolic BP of 130-139 mmHg or a diastolic BP of 80-89 mmHg. Stage I would benefit from treatment, either through lifestyle changes or medication.
- Stage II hypertension is a systolic BP of 140 mmHg or higher or a diastolic BP of 90mmHg or higher. Stage II requires treatment with both lifestyle changes and one to two medications.
How do you feel when you have high blood pressure?
Most people who have high blood pressure don’t have any symptoms. But over time, it silently contributes to serious conditions, including stroke, heart attack, congestive heart failure, and kidney disease.
Some people experience sudden increases in their blood pressure, which causes serious symptoms. Get emergency care if you develop these potential signs of high blood pressure:
What causes high blood pressure?
High blood pressure can be either primary (the most common form) or secondary. The cause of primary hypertension is unclear. Some risk factors for developing primary hypertension include:
- Advanced age
- High salt intake
- High alcohol intake
- Family history of hypertension
Secondary hypertension is caused by another medical problem, like certain adrenal gland issues, kidney problems, some prescription medications, and sleep apnea.
The long-term effects on the heart and kidneys from years of poorly controlled blood pressure can cause very serious conditions. The surprising thing, however, is that those heart and kidney complications can be treated and even reversed with the appropriate blood pressure management. —Dr. Patel
What is transient or white coat hypertension?
Transient hypertension is high blood pressure that occurs only in certain situations. For many people, it happens in high-stress situations. Exercise is also associated with transient hypertension, but this is normal.
Transient hypertension that happens when patients visit their doctor is called white coat hypertension. It’s most commonly related to anxiety triggered by being at a doctor’s office. To make sure your blood pressure is in the normal range outside of the doctor’s office, you may be given a blood pressure monitor to wear throughout the day, or be asked to check your blood pressure at home regularly.
Given the number of different kinds of medications for treating high blood pressure, discuss with your doctor which is best for you. Some medications may have unwanted side effects if you have certain other diagnoses, while other medications may have beneficial effects if you have certain other diagnoses. —Dr. Patel
How to lower high blood pressure
Making changes to improve your diet and increasing your exercise routine can help lower blood pressure. These changes may be enough if you have borderline or stage 1 hypertension. But if your blood pressure is very elevated, you will also need to take medication.
The DASH eating plan stands for the Dietary Approach to Stop Hypertension. This diet is backed by the National Heart, Blood, and Lung Institute (NHLBI). It is a low salt, low saturated fat diet with lots of fruits, vegetables, low-fat dairy products, and whole grains. It also has high amounts of potassium and magnesium, which help control blood pressure.
If you have elevated or high blood pressure, it's very important to monitor your salt intake. Sodium balance in the body is controlled by the kidneys, which normally do a great job at eliminating excess sodium.
But if your salt intake is too high, the kidneys hang on to some of that extra sodium, which leads to water retention. This creates extra volume in the blood vessels, increasing blood pressure. It’s easier to lower your salt intake if you cook at home, because food from restaurants is often very high in salt.
Maintain a healthy weight
Maintaining a healthy weight helps keep your blood pressure under control. It also lowers your risk of other conditions that may contribute to hypertension like sleep apnea.
For every two pounds of weight loss, you can expect a 1 mmHg drop in your systolic and diastolic blood pressure.
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Smoking increases your risk of complications from chronic hypertension. Nicotine in cigarettes ramps up the body’s sympathetic nervous system, which is responsible for the “fight-or-flight” response.
Cutting out this excess stimulation will naturally decrease blood pressure because the blood vessels will be more relaxed. Some studies suggest that quitting smoking can decrease systolic blood pressure by approximately 5 mmHg.
Aerobic exercise, such as running or cycling, and strength training both reduce systolic and diastolic blood pressure. They also can help you lose weight. It’s not well understood how exercise lowers blood pressure, but it is thought to reduce inflammation and constriction of blood vessels and improve sodium sensitivity.
Try to do moderate-intensity exercise 3-4 days a week for at least 40 minutes. Exercising regularly for several months can reduce blood pressure by approximately 5-8 mmHg.
Reduce alcohol intake
Not drinking a lot of alcohol can lower your blood pressure. One study found that men who drank fewer than 2 drinks a day and women who had fewer than 1 drink a day reduced their systolic and diastolic blood pressure by approximately 4 mmHg.
If lifestyle changes aren’t enough to bring blood pressure down to a normal range, then prescription medication will be recommended. There are several kinds of blood pressure medications available, including:
- Diuretics (hydrochlorothiazide, chlorthalidone, furosemide, spironolactone). These help your body get rid of sodium and water.
- Calcium channel blockers (amlodipine, nifedipine). These relax and dilate (widen) the blood vessel walls to reduce the pressure.
- ACE inhibitors and ARBs (lisinopril, enalapril, losartan, valsartan). These reduce the effect of certain substances, such as the hormone angiotensin, that constrict blood vessels.
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