High Blood Pressure

	Overview
	Health Tools
	FAQs
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When to Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Living With High Blood Pressure
	Medications
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits
	Audio articles:
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What is high blood pressure?

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It’s normal for blood pressure to go up and down throughout the day, but if it stays up, you have high blood pressure. Another name for high blood pressure is hypertension.

When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. High blood pressure is called a "silent killer,'' because it doesn't usually cause symptoms while it is causing this damage.

Your blood pressure consists of two numbers: systolic and diastolic. Someone with a systolic pressure of 120 and a diastolic pressure of 80 has a blood pressure of 120/80, or "120 over 80."

• The systolic number shows how hard the blood pushes when the heart is pumping.
• The diastolic number shows how hard the blood pushes between heartbeats, when the heart is relaxed and filling with blood.

Adults should have a blood pressure of less than 120/80. High blood pressure is 140/90 or higher. Many people fall into the category in between, called prehypertension. People with prehypertension need to make lifestyle changes to bring the blood pressure down and help prevent or delay high blood pressure.

What causes high blood pressure?

In most cases, doctors can't point to the exact cause. But several things are known to raise blood pressure, including being very overweight, drinking too much alcohol, having a family history of high blood pressure, eating too much salt, and getting older.

Your blood pressure may also rise if you are not very active, you don't eat enough potassium and calcium, or you have a condition called insulin resistance.

What are the symptoms?

High blood pressure doesn't usually cause symptoms. Most people don't know they have it until they go to the doctor for some other reason.

Without treatment, high blood pressure can damage the heart, brain, kidneys, or eyes. This damage causes problems like coronary artery disease, stroke, and kidney failure.

Very high blood pressure can cause headaches, vision problems, nausea, and vomiting. These symptoms can also be caused by dangerously high blood pressure called malignant high blood pressure. It may also be called a hypertensive crisis or hypertensive emergency. Malignant high blood pressure is a medical emergency.

How is high blood pressure diagnosed?

Most people find out they have high blood pressure during a routine doctor visit. For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart.

You may have to check your blood pressure at home if there is reason to think the readings in the doctor’s office aren't accurate. You may have what is called white-coat hypertension, which is blood pressure that goes up just because you're at the doctor’s office. Even routine activities, such as attending a meeting, can raise your blood pressure. So can commuting to work or smoking a cigarette.

How is it treated?

Treatment depends on how high your blood pressure is, whether you have other health problems such as diabetes, and whether any organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease.

You can help lower your blood pressure by making healthy changes in your lifestyle. If those lifestyle changes don't work, you may also need to take pills. Either way, you will need to control your high blood pressure throughout your life.

• If you have prehypertension, your doctor will likely recommend lifestyle changes. These may include losing extra weight, exercising, limiting alcohol, cutting back on salt, quitting smoking, and eating a low-fat diet that includes more fruits, vegetables, whole grains, and low-fat dairy foods.
• If you have high blood pressure without any organ damage or other risk factors for heart disease, your doctor may recommend that you take medicine in addition to making lifestyle changes.
• If you have high blood pressure and have some organ damage or other risk factors for heart disease, you may need to try various combinations of medicines in addition to making big lifestyle changes.

Most people take more than one pill for high blood pressure. Work with your doctor to find the right pill or combination of pills that will cause the fewest side effects.

It can be hard to remember to take pills when you have no symptoms. But your blood pressure will go back up if you don't take your medicine. Make your pill schedule as simple as you can. Plan times to take them when you are doing other things, like eating a meal or getting ready for bed.

What can you do to prevent high blood pressure?

Making lifestyle changes can help you to prevent high blood pressure. You can:

• Stay at a healthy weight or lose extra weight.
• Eat less salt and salty foods.
• Exercise regularly.
• Drink alcohol moderately. Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
• Follow the DASH eating plan (Dietary Approaches to Stop Hypertension). This diet is rich in fruits, vegetables, and low-fat dairy products and is low in fat.

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	High blood pressure: Should I take medicine?
	Actionsets are designed to help people take an active role in managing a health condition.
	Fitness: Adding more activity to your life
	Healthy eating: Changing your eating habits
	Healthy eating: Getting support when changing your eating habits
	Healthy eating: Starting a plan for change
	High blood pressure: Checking your blood pressure at home
	High blood pressure: Taking medicines properly
	High blood pressure: Using the DASH diet
	Positive thinking: Stopping unwanted thoughts
	Quitting smoking: Coping with cravings and withdrawal
	Quitting smoking: Getting support
	Stress Management: Doing Meditation
	Stress Management: Doing Progressive Muscle Relaxation
	Weight Management: Using Positive Thinking

Experts know that many different factors are linked to high blood pressure. But experts still don't fully understand the exact cause. Factors that are linked to high blood pressure include:

• Aging.
• Drinking more than 2 alcohol drinks a day for men or more than 1 alcohol drink a day for women.
• Eating a lot of sodium (salt).
• Being overweight or obese.
• Having high cholesterol.
• Not exercising.
• Being under a lot of stress.
• Eating a diet low in potassium, magnesium, and calcium.
• Being insulin-resistant.

Primary, or essential, high blood pressure accounts for almost all cases of hypertension. Secondary high blood pressure, which is caused by another disease or medicine, is less common.

Elevated blood pressure readings may not always mean that you have high blood pressure. For some people, just being in a medical setting causes their blood pressure to rise. This is called white-coat hypertension.

People with primary (essential) high blood pressure usually do not have any symptoms. Most people with high blood pressure feel fine. It's during a routine exam or a doctor visit for another problem that they find out they have high blood pressure.

Very severe high blood pressure (160 over 100 or higher) may lead to malignant high blood pressure. This is also called hypertensive emergency or hypertensive crisis. Very severe high blood pressure is a medical emergency. Symptoms of very severe high blood pressure include:

• Headaches, especially pulsating headaches behind the eyes that occur early in the morning.
• Visual disturbances.
• Nausea and vomiting.

Over time, untreated high blood pressure can damage organs, such as the heart, kidneys, or eyes. This may lead to:

• Chest pain (angina), heart attack, or heart failure.
• Stroke.
• Kidney (renal) failure.
• Peripheral arterial disease.
• Eye damage (retinopathy).
• Abnormal heartbeat.

Healthy arteries have smooth inner walls. Your blood flows through them without a problem. The blood vessels stay strong and flexible.

But when you have high blood pressure, blood flows through your arteries with too much force, even though you can't feel it. Over time, this damages the walls of your arteries. They aren't smooth anymore. They get rough spots on them where fat and calcium start to build up. This buildup is called plaque (say "plak").

Plaque makes your arteries narrower. It also makes them stiffer. Blood can't flow through them as easily. This lack of good blood flow starts to damage some of the organs in your body. See a picture of how high blood pressure damages arteries.

This damage leads to:

• Coronary artery disease and heart attack.
• Heart failure.
• Stroke.
• Kidney failure.
• Peripheral arterial disease.
• Eye damage.

This damage doesn't happen all at once. It happens slowly over time. But you can't tell that it's happening, because you don't feel anything.

Other types of high blood pressure

• Prehypertension. This is blood pressure that is higher than normal but not high enough to be high blood pressure (between 120/80 and 140/90). It is a warning that your blood pressure is going up. People with this type of blood pressure are more likely to get high blood pressure and heart disease than people with normal blood pressure.
• Secondary high blood pressure. Sometimes high blood pressure is caused by something else, such as kidney disease, pregnancy, or medicine.
• Isolated systolic high blood pressure. This means that systolic blood pressure (the first number in a blood pressure reading) is higher than 140, but diastolic blood pressure (the second number) stays lower than 90. This type of high blood pressure is more common in older adults, especially older women.

Some people only have high blood pressure when they're at the doctor’s office. This is called white-coat hypertension. If your doctor thinks this is getting in the way of measuring your true blood pressure, you may need to get your blood pressure measured away from the doctor's office.

Very high blood pressure is called malignant high blood pressure. It is so high that it can damage organs like the eyes and kidneys. It is an emergency. It may happen if someone suddenly stops taking blood pressure medicine or misses a dose of medicine. It may be caused by a medicine or another condition. Or the cause may not be known. This problem is also called hypertensive crisis or hypertensive emergency.

Risk factors for high blood pressure include:

• A family history of high blood pressure.
• Aging.
• Eating a lot of sodium (salt).
• Drinking more than 2 alcohol drinks a day for men or more than 1 alcohol drink a day for women.
• Being overweight or obese.
• Lack of exercise or physical activity.
• High cholesterol.
• Race. African Americans are more likely to get high blood pressure, often have more severe high blood pressure, and are more likely to get the condition at an earlier age than others. Why they are at greater risk is not known.

Other possible risk factors include:

• Low intake of potassium, magnesium, and calcium.
• Sleep apnea and sleep-disordered breathing.
• Long-term use of pain medicines like NSAIDs—for example, naproxen (such as Aleve) or ibuprofen (such as Motrin or Advil)—or COX-2 inhibitors, such as celecoxib (Celebrex). Aspirin does not increase your risk for getting high blood pressure.

People who have high blood pressure along with any of the following risk factors are at increased risk for getting complications, such as coronary artery disease, heart attack, stroke, kidney failure, and eye damage (retinopathy). These risk factors are:

• Cigarette smoking.
• High cholesterol or low HDL ("good") cholesterol.
• Diabetes.
• Having one or more close relatives who have or had early coronary artery disease.
• Being a male.
• Being an African American.
• Being overweight.
• Not getting enough exercise.

Call a doctor immediately if you have high blood pressure and:

• Your blood pressure is 180/110 or higher.
• You think high blood pressure is causing headaches or other symptoms.

Call a doctor if:

• Your blood pressure is 140/90 or higher on two or more occasions.
• You think you may be having side effects from your blood pressure medicine.
• Your blood pressure is usually normal and well controlled, but it goes above the normal range on more than one occasion.

Adults are encouraged to have their blood pressure checked regularly.

Who to See

Your blood pressure can be checked:

• At a clinic where you work or go to school.
• At health fairs, fitness centers, community centers, fire stations, and ambulance stations.
• By a nurse practitioner or physician assistant.
• By a primary care doctor.

For diagnosis and management of high blood pressure, see:

• A primary care doctor.
• An internist.
• A cardiologist (heart specialist). In general, a cardiologist is needed only in cases of extremely high blood pressure or when the person has other serious heart problems.
• A nephrologist (kidney specialist), in extreme cases.
• A nurse practitioner.
• A physician assistant.

The main test for high blood pressure is simple, fast, and painless. These are the usual steps:

1. You sit quietly for 5 minutes before the test, with both feet flat on the floor.
2. You sit down with your arm resting on the arm of the chair so that the arm is level with your heart.
3. An inflatable sleeve, called a cuff, is wrapped around your upper arm. It’s attached to a dial that will show your blood pressure numbers.
4. The nurse (or other health professional) seals the cuff and pumps it up. You feel tight pressure as the cuff cuts off the blood flow in your arm.
5. Next, the nurse slowly loosens the cuff while using a stethoscope to listen to the heartbeat in your inner elbow. When the cuff is just loose enough that blood starts to flow again and the nurse can hear it, that is your systolic blood pressure.
6. The cuff is slowly loosened some more. When it’s loose enough that your heartbeat can no longer be heard through the stethoscope, that is your diastolic blood pressure.

If this test shows that your blood pressure is high, your doctor will likely have you come in two more times to be tested. This will confirm that you have high blood pressure.

Some people only have high blood pressure when they're at the doctor’s office. This is called white-coat hypertension. If your doctor thinks this is getting in the way of measuring your true blood pressure, you may need to get your blood pressure measured away from the doctor's office.

Regular blood pressure checks

All adults should have their blood pressure checked regularly. Experts recommend:¹

• At least every 1 to 2 years if your blood pressure is normal (119/79 or lower).
• At least every year—or as often as your doctor recommends—if you have prehypertension. This means your systolic pressure (the first number) is 120 to 139 and your diastolic pressure (the second number) is 80 to 89.
• More often if you have other risk factors for heart disease or evidence of disease caused by high blood pressure.

The automated devices you find in grocery stores or drugstores may not be accurate. Having your blood pressure checked at the doctor's office is best.

A home blood pressure monitor makes it easy to keep track of your blood pressure. It's a good idea to bring your home monitor to the doctor's office to check its accuracy. For more information, see:

High blood pressure: Checking your blood pressure at home.

Other tests

Besides taking your blood pressure, your doctor will do a physical exam and ask you questions about your medical history. Your doctor may also have you get other tests to find out whether high blood pressure has damaged any organs or caused other problems. These tests may include:

• Urine tests to check for kidney or liver disease.
• Blood tests to check your levels of potassium, sodium, and cholesterol.
• A blood glucose test to check for diabetes.
• Tests to measure kidney function.
• An electrocardiogram (EKG, ECG) to find out whether there is any damage to the heart. Your doctor may also check your risk of coronary artery disease.

In some cases, you may be asked to check your blood pressure at home and keep a record of the readings. If you can't do this, you may need ambulatory blood pressure monitoring. This means wearing a special device for 24 to 48 hours. The device automatically takes your blood pressure throughout the day.

Sometimes doctors automatically schedule routine tests because they think that's what patients expect. But experts say that routine heart tests can be a waste of time and money. For more information, see Heart Tests: When Do You Need Them?

Secondary high blood pressure

Secondary high blood pressure is high blood pressure that is caused by another disease or condition. It can also be caused by certain medicines. Your doctor may suspect that you have secondary high blood pressure if:

• Your blood pressure has suddenly gone up since it was last checked.
• You are young and your blood pressure is 160/100 or higher.
• You have had many treatments and medicines for high blood pressure, but it is still 160/100 or higher.
• You have symptoms of conditions that may raise blood pressure, such as obesity or muscle weakness from Cushing's syndrome.
• Your kidneys don't work as well as they should.

If your doctor thinks that you may have secondary high blood pressure, you may need tests to diagnose other health problems. Your doctor will also check any medicines that you take, since some medicines can cause high blood pressure as a side effect.

Untreated high blood pressure can lead to fatal heart attacks or strokes. The higher your blood pressure, the greater your risk. Lowering blood pressure lowers the risk of damaging blood vessels and getting atherosclerosis.

High blood pressure usually can't be cured. But it can be controlled. The two types of treatment for high blood pressure are:

• Lifestyle changes, including healthy eating, losing extra weight, and getting more active.
• Daily medicines.

For most people, the goal of treatment is to get the blood pressure below 140/90. But a person's goal may be lower. Your doctor will give you a blood pressure goal that is based on your health. For example, your goal may be lower if you have other conditions such as diabetes, heart failure, coronary artery disease, or chronic kidney disease

Treating high blood pressure usually is a lifelong effort.

Treating high blood pressure with lifestyle changes

Your doctor may suggest that you make one or more of the following changes:

• Lose weight. If you're overweight, losing extra pounds may bring your blood pressure down. You'll also be less likely to have other weight-related problems, including heart disease, stroke, arthritis, diabetes, and some forms of cancer. For more information, see:

  Healthy eating: Changing your eating habits.

• Get more active.Physical activity reduces blood pressure, especially if you have been inactive until now. People who don't exercise are more likely to get high blood pressure. See:

  Fitness: Adding more activity to your life.

• Stop smoking. Nicotine temporarily increases blood pressure and heart rate with each use. Smoking also causes the arteries to tighten (constrict), which also increases blood pressure. See:
  • Quitting Smoking.
• Cut back on drinking. Limit alcohol to 2 drinks a day for men, 1 drink a day for women. See:
  • Quick Tips: Cutting Back on Drinking.
• Eat less salt. Eating less salt can help control high blood pressure in elderly people. See:
  • Reduce salt in your diet.
• Follow theDASH diet. The calcium, potassium, and magnesium found in fruits, vegetables, and dairy foods help lower blood pressure. The DASH (Dietary Approaches to Stop Hypertension) eating plan can help you get the right amounts of these nutrients. See:

  High blood pressure: Using the DASH diet.

  A chart that compares DASH with other heart-healthy diets(What is a PDF document?) .

Treating high blood pressure with medicines

If lifestyle changes don't work to lower your blood pressure, you probably need to take daily medicines as well.

Medicines control—but usually don't cure—high blood pressure. So you will probably need to take them for the rest of your life. Most people need to take two or more medicines.

For more information, see:

High blood pressure: Should I take medicine?

Some people find it hard to take their medicines properly. They may fit into one of these groups:

• "Why should I bother?" These people don't see why they should take medicines every day when they don't feel sick.

  High blood pressure doesn't usually make you feel sick. But it's important to treat high blood pressure, because it damages your organs, even though you can't feel anything.

• "I don't like the side effects." These people stop taking their medicines because they are having side effects from the pills.

  If you're having side effects, tell your doctor. There are many kinds of medicines you can try until you find one that works well with the fewest side effects.

• "I just can't keep track." Some people find it very hard to keep track of taking two or more pills every day, especially if they need to take them at different times.

  Your doctor may be able to change your pill schedule to make it simpler. You can also organize your pills with a pillbox that holds a week's worth of pills. Some of these boxes have separate compartments for morning, noon, and bedtime pills.

For more information, see the topics:

• Taking Medicines as Prescribed.
• Dealing With Medicine Side Effects and Interactions.

If you have trouble taking high blood pressure medicines for any reason, talk to your doctor.

For more information, see:

High blood pressure: Taking medicines properly.

People who need special treatment

Some people with high blood pressure need special treatment:

• Older adults.
• African Americans.
• Children.
• Pregnant women.
• People with heart disease. They have a high risk for future heart problems. It's very important for them to get treatment for their high blood pressure.

Treatment of secondary high blood pressure depends on the cause. For example, treatment of high blood pressure caused by kidney disease will also include treating the kidney problem. Even if the condition that caused your high blood pressure is treated, you may still have to take blood pressure medicine throughout your life.

Lifestyle changes can help you prevent high blood pressure. These changes are especially important for people who have risk factors for high blood pressure that cannot be changed, including family history, race, or age.

Lifestyle changes include:

• Staying at a healthy weight, with a body mass index (BMI) of 18.5 to 24.9.
• Reducing sodium in your diet to less than 2,300 mg a day, which is about 1 teaspoon of salt.
• Exercising, such as brisk walking, that raises your heart rate. Aim for at least 2½ hours of moderate exercise a week.
• Limiting alcohol drinks to 2 drinks a day for men and 1 drink a day for women.
• Following the Dietary Approaches to Stop Hypertension (DASH) eating plan, a diet that is rich in fruits, vegetables, and low-fat dairy products, with reduced amounts of saturated and total fats. For more information, see:

  High blood pressure: Using the DASH diet.

  A chart that compares DASH with other heart-healthy diets(What is a PDF document?) .

Lifestyle changes are important to help control high blood pressure, especially if you have other risk factors for heart disease and stroke.

Even if your doctor has prescribed medicine for you, you can still take many steps at home to lower your blood pressure and reduce your risk. Some people can even take less medicine after making these changes.

What changes do you need to make?

Make these lifestyle changes to help lower your blood pressure:

• Lose extra weight. If you are overweight, losing as little as 10 lb (4.5 kg) may lower your blood pressure. It may also allow you to take less blood pressure medicine. Losing weight may also lower your cholesterol. For help, see:

  Healthy eating: Starting a plan for change.

  Weight management: Using positive thinking.

• Eat healthy foods. Getting enough of the nutrients found in fruits, vegetables, and dairy products helps lower blood pressure. Use the DASH eating plan as a guide. See:

  High blood pressure: Using the DASH diet.

• Get active. Regular physical activity can lower blood pressure in those who have high blood pressure.² See:

  Fitness: Adding more activity to your life.

• Don't smoke. Nicotine temporarily increases blood pressure and heart rate with each use. Smoking also causes the arteries to tighten (constrict), which also increases blood pressure. For more information, see the topic Quitting Smoking. And for more help, see:

  Quitting smoking: Getting support.

  Quitting smoking: Coping with cravings and withdrawal.

• Drink less alcohol. Alcohol increases blood pressure. Drink it in moderation, if at all. That means no more than 2 drinks a day for men, or 1 drink a day for women. See:
  • Quick Tips: Cutting Back on Drinking.
• Cut back on salt. Eating less salt can help prevent and control high blood pressure. Learn how to:
  • Eat less salt.
  • Make your own salt substitute.
• Manage stress. Your blood pressure increases when you are under stress. Relaxation techniques, including progressive muscle relaxation and meditation, may help lower mild high blood pressure. For more information, see the topic Stress Management. And to learn some techniques, see:

  Stress management: Doing progressive muscle relaxation.

  Stress management: Doing meditation.

• Check your own blood pressure. A home blood pressure monitor makes it easy to keep track of your blood pressure. Seeing those small improvements can motivate you to keep going with your lifestyle changes. To learn more, see:

  High blood pressure: Checking your blood pressure at home.

How do you make lifestyle changes?

Making any kind of change in the way you live your daily life is like being on a path. The path leads to success. Here are the first steps on that path:

1. Have your own reason for making a change. If you do it because someone else wants you to, you're less likely to have success.
2. Set goals. Include long-term goals as well as short-term goals that you can measure easily.
3. Measure improvements to your health. For example, keep track of your blood pressure, cholesterol, or blood sugar. Or see how you can shorten the time it takes to walk a mile.
4. Think about what might get in your way, and prepare for slip-ups.
5. Get support from your family, your doctor, your friends—and from yourself.

1. Have your own reason

Your reason for wanting to make a lifestyle change is really important. When you have high blood pressure, the reason for making lifestyle changes is clear: to lower your blood pressure.

But it's very important that you feel ready to make changes. If you don't feel ready now, learn more about high blood pressure and the damage it can do. When you truly want to make changes, you're ready for the next step.

It's not easy to change habits. But taking the time to really think about what will motivate or inspire you will help you reach your goals.

2. Set goals you can reach

Ask yourself if you feel ready to begin taking steps toward big goals. If you're not ready yet, try to pick a date when you will start making small changes. Any healthy change—no matter how small—is a good start.

When you are clear about your reasons for wanting to make a change, it's time to set your goals.

• Long-term goals: These are large goals that you want to reach in 6 to 12 months. Your doctor can help you figure out what your long-term goals should be for your blood pressure.
• Short-term goals: What are the short-term goals that will help you reach your long-term goals? Short-term goals are the small steps you take, week by week, to improve your health.
• Updated goals: To help you stay motivated, track your progress and update your goals as you move forward.

3. Measure how your health has improved

Before you make lifestyle changes, ask your doctor to check your blood pressure. Then, as you start to make changes, have your blood pressure checked often, and keep track of the numbers. You can:

• Visit your doctor's office every week. Most clinics will gladly check a patient's blood pressure for free.
• Check your blood pressure at home. You can buy a home blood pressure monitor that is easy to use.

  High blood pressure: Checking your blood pressure at home

• Use an automatic blood pressure device at a local drugstore or grocery store. Although these devices aren't always accurate, if you use one regularly you may be able to see if your blood pressure goes down.

4. Prepare for slip-ups

It's perfectly normal to try to change a habit, go along fine for a while, and then have a setback. Lots of people try and try again before they reach their goals.

What are the things that might cause a setback for you? If you have tried to make lifestyle changes before, think about what helped you and what got in your way.

By thinking about these barriers now, you can plan ahead for how to deal with them if they happen.

Use a personal action plan(What is a PDF document?) to write down your barriers and backup plans.

There will be times when you slip up and don't make your goal for the week. When that happens, don't get mad at yourself. Learn from the experience. Ask yourself what got in the way of making your goal. Positive thinking goes a long way when you're making lifestyle changes.

Positive thinking: Stopping unwanted thoughts

4. Get support

The more support you have for making lifestyle changes, the easier it is to make those changes.

You can use this personal action plan(What is a PDF document?) to organize your support system.

Deciding whether to treat high blood pressure with medicine and choosing the best medicine are based mainly on:

• How high your blood pressure is.
• Whether you have signs that high blood pressure has caused organ damage, such as an enlarged heart or early damage to your arteries, kidneys, or eyes.
• Whether you have other medical conditions, such as coronary artery disease, diabetes, or kidney or lung disease or risk factors for heart disease, such as diabetes or high cholesterol.
• Whether you think you can succeed at making lifestyle changes.

Doctors may have different opinions about when to start medicines for high blood pressure.

• Lifestyle changes alone may be tried before medicine if you have prehypertension (120–139/80–89 millimeters of mercury [mm Hg]) or high blood pressure (140/90 mm Hg), if you do not have other risk factors for heart disease, and if there's no evidence of organ damage.
• Treatment with medicine is often started along with lifestyle changes if you have other risk factors for heart disease, if there are signs of damage to organs, or if you have stage 1 or 2 high blood pressure.

Doctors usually prescribe a single, low-dose medicine first. If blood pressure is not controlled, your doctor may change the dosage or try a different medicine or combination of medicines. It is common to try several medicines before blood pressure is successfully controlled. Many people need more than one medicine to get the best results. African Americans with blood pressure that is higher than 10 to 15 mm Hg above their goal may need to take a combination of medicines first.³ For more information, see:

High blood pressure: Should I take medicine?

Medicine Choices

Medicine choices include:

• Diuretics.
• ACE inhibitors.
• Angiotensin II receptor blockers (ARBs).
• Beta-blockers.
• Calcium channel blockers.
• Vasodilators.
• Direct renin inhibitors.

All of these medicines are effective for lowering the risk of heart attack and stroke.

Treatment for high blood pressure is different for each person and is based on your risk factors, such as diabetes, smoking, and heart disease. Although one study may recommend a particular medicine as the first line of treatment, it may not be best for you based on your medical condition.

What's most important is that you work with your doctor to find the right medicine or combination of medicines that have the fewest side effects and work well for you, and that you take your medicines regularly as prescribed.

High blood pressure: Taking medicines properly

High blood pressure guidelines from the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommend that, for most people, one of the medicines be a thiazide-type diuretic.

If other conditions, such as heart failure or diabetes, are present, ACE inhibitors or ARBs often are used as the first line of therapy, because the other medical conditions also may benefit from these medicines. But isolated systolic hypertension may respond best to diuretics alone.

What to Think About

• Your doctor may choose which medicine to give you for high blood pressure based on whether you have any other related conditions. For example, doctors often prescribe ACE inhibitors for people with diabetes or heart failure.
• Some people who get a cough while taking ACE inhibitors do well with ARBs, which usually do not cause a cough.
• Strategies for treating high blood pressure in pregnant women are quite different. For more information, see the topic Preeclampsia and Hypertension During Pregnancy.
• Some experts believe that a combination of medicines, each given in a lower dose, is better for reducing blood pressure than a higher dose of a single medicine. Because the medicines that are combined are given in a lower dose, there may be fewer side effects.

Check with your doctor before you take any nonsteroidal anti-inflammatory drugs (NSAIDs)—for example, aspirin or ibuprofen—with high blood pressure medicines. NSAIDs may raise blood pressure and keep your blood pressure medicines from working well.

In addition to making lifestyle changes, you can also try several other nondrug methods of reducing blood pressure.

• None of the methods listed below are proved to consistently lower high blood pressure. But these methods generally are considered to be safe and may have other benefits besides lowering blood pressure.
• Although there may be a link between a certain stressful situation and high blood pressure, this does not prove that changing the situation will affect blood pressure.
• Because it is simple to check your blood pressure, you can easily track the effects of these treatment methods on lowering your blood pressure. See:

  High blood pressure: Checking your blood pressure at home.

Other Treatment Choices

Alternative or complementary medicine treatments that help reduce stress and improve quality of life may have some effect on blood pressure. These treatments include:

• Acupuncture.
• Biofeedback.
• Guided imagery.
• Hypnosis.
• Meditation.
• Stress management.
• Yoga.

Although eating garlic and onions has been recommended to reduce blood pressure, evidence shows that only very small decreases in blood pressure may result. Fish oil (omega-3 fatty acids) also may have some effect on lowering blood pressure.

Not eating enough foods containing potassium, calcium, and magnesium may contribute to high blood pressure. Most people will get enough of these minerals by eating a balanced diet that contains plenty of fresh fruits, vegetables, dairy foods, whole grains, and legumes (cooked dried beans and peas). Taking supplements instead of eating these foods does not have the same effect.

What to Think About

Many of the complementary medicine options listed above don't cost much and are probably not harmful. But it is best to work with your doctor when using these other methods along with traditional medical treatments.

The safest way to ensure good nutrition is through a balanced, varied diet instead of through nutritional supplements.

Acupuncture is currently being studied, and it shows some promise in lowering blood pressure.⁴

Organizations

Related Information

• Chronic Kidney Disease
• Complementary Medicine
• Coronary Artery Disease
• Early Disease Detection
• Heart Attack and Unstable Angina
• Heart Failure
• Stress Management
• Stroke
• Type 1 Diabetes
• Type 2 Diabetes

Citations

1. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express (NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and Human Services.

2. Simon HB (2003). Diet and exercise. In DC Dale, DD Federman, eds., Scientific American Medicine, Clinical Essentials, chap. 4. New York: WebMD.

3. Douglas JG (2005). Clinical guidelines for the treatment of hypertension in African Americans. American Journal of Cardiovascular Drugs, 5(1): 1–6.

4. Flachskampf FA, et al. (2007). Randomized trial of acupuncture to lower blood pressure. Circulation, 115(24): 3121–3129.

Other Works Consulted

• American Heart Association. (2005). Recommendations for blood pressure measurement in humans and experimental animals. Part 1: Blood pressure measurement in humans. AHA Scientific Statement. Hypertension, 45(1): 142–161.

• Appel LJ, et al. (2006). Dietary approaches to prevent and treat hypertension: A scientific statement from the American Heart Association. Hypertension, 47(2): 296–308.

• Drugs for hypertension (2009). Treatment Guidelines From The Medical Letter, 7(77): 1–10.

• Falkner B, Daniels SR (2004). Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension, 44(4): 387–388.

• Henri HC, Rudd P (2007). Hypertension: Context and management. In EJ Topol, ed., Textbook of Cardiovascular Medicine, 3rd ed., pp. 88–108. Philadelphia: Lippincott Williams and Wilkins.

• National Heart, Lung, and Blood Institute (2006). Your Guide to Lowering Your Blood Pressure With DASH (NIH Publication No. 06-4082). Available online: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf.

• Rashidi A, et al. (2008). Diagnosis and treatment of hypertension. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 1610–1629. New York: McGraw-Hill Medical.

• Rosendorff C, et al. (2007). Treatment of hypertension in the prevention and management of ischemic heart disease: A scientific statement from the American Heart Association Council for High Blood Pressure Research and the Council on Clinical Cardiology and Epidemiology and Prevention. Circulation, 115(21): 2761–2788.

• Schwartz GL, Sheps SG (2006). Hypertension. In DC Dale, DD Federman, eds., ACP Medicine, section 1, chap 3. New York: WebMD.

• Sheridan SL (2007). Primary prevention: Hypertension, search date March 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

• Victor RG (2008). Arterial hypertension. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 23rd ed., pp. 430–450. Philadelphia: Saunders.