High blood pressure, or hypertension, is a serious condition that affects about one in three American adults, and two-thirds of people over age 65. Blood pressure is the force of blood as it pumps through your arteries. The more blood your heart pumps and the narrower your arteries are, the higher the blood pressure.
Normal blood pressure is an average systolic blood pressure of less than 120 mm Hg and an average diastolic pressure of less than 80 mm Hg, "120 over 80." The top number measures the pressure in arteries when your heart beats. The bottom number measures the pressure between beats. Someone has high blood pressure when the average top number is above 140 mm Hg, the bottom number is above 90 mm Hg, or both.
High blood pressure raises the risk of heart disease and stroke, the leading causes of death among Americans. It is called the "silent killer" because most people dont have any symptoms when blood pressure is too high. Hypertension, high cholesterol, and obesity are the biggest reasons people get atherosclerosis, or hardening of the arteries.
Most people can control their high blood pressure and reduce their risk of heart disease. Talk to your doctor about how to lower your high blood pressure. In some cases, making changes in your diet and exercising can get blood pressure under control. In other cases, you may need medications.
Signs and Symptoms
Most people do not know they have high blood pressure because they have no symptoms. Rarely, some people may have a mild headache when their blood pressure is high. Advanced cases of hypertension may cause these symptoms:
There are two major types of high blood pressure: essential, or primary, and secondary. Primary hypertension is the most common. It makes up more than 95% of all cases. Scientists do not know what causes it. A number of things may be involved, including:
Secondary hypertension has an underlying cause, which may include:
The following factors increase your risk for high blood pressure:
Each time your heart beats, or contracts, it pumps blood into your arteries. The pressure of the blood against the artery walls is called systolic blood pressure, when blood pressure is at its maximum. When your heart is at rest, between beats, the blood pressure falls, which is known as the diastolic pressure. A person with high blood pressure has an average systolic blood pressure above 140 mm Hg and/or a diastolic blood pressure above 90 mm Hg, usually written as 140/90.
To diagnose hypertension, your doctor will check your blood pressure using an inflatable cuff and a stethoscope. If it is high, your doctor will check your pulse rate, examine your neck for swollen veins or an enlarged thyroid gland, listen to your heart for murmurs, and look at your eyes for damaged blood vessels in the retina. If your doctor thinks you have high blood pressure, you may be asked to measure your blood pressure at home or to come back for another appointment. Additional laboratory and blood tests can determine whether it is secondary or primary hypertension.
There are several ways you can prevent high blood pressure.
Stay at a proper weight
A number of large-scale studies have found that being overweight is one of the strongest predictors of high blood pressure. That is true for teens and young adults as well as adults. Staying at a healthy weight is one of the best things you can do to prevent hypertension. If you are overweight, ask your doctor or nutritionist how to safely lose weight by eating a balanced diet. Even losing just as few pounds may help.
Cut back on salt
Cutting back on salt can help lower blood pressure for some people. Healthy people should get no more than 2,400 mg per day, and less is better. Even if you do not add salt to your food, you may be getting much more than that from canned, processed, and restaurant foods.
Get more exercise
Several studies found that people who do not get much physical activity may be at higher risk of developing hypertension. According to some studies, men who lead physically active lives can lower their risk of developing hypertension by 35 to 70 %. Regular exercise also helps keep your weight in check. Aim for at least 30 minutes of moderate exercise, such as a brisk walk, every day. Ask your doctor before starting a new exercise routine.
Studies suggest that people who have three or more alcoholic drinks per day have a greater chance of developing hypertension. If you drink alcohol, have no more than one drink per day if you are a woman and two if you are a man.
Eat a diet rich in fruits and vegetables
Most Americans eat too much saturated fat and not enough fruits and vegetables. The Dietary Approaches to Stop Hypertension (DASH) diet, which recommends fruits, vegetables, whole grains and low-fat dairy, is often suggested for those who have high blood pressure. It also can help people who are at risk of developing the condition.
If you have high blood pressure, work with your doctor to reduce the risk of serious complications, including heart disease and stroke, by getting it under control. Ideally, you want your blood pressure to be 120/80 mm Hg, but even modest reduction in pressure can help.
In the early stages of hypertension when blood pressure is not very high, your doctor may tell you to make lifestyle changes for 6 to 12 months. After this time, if blood pressure is still high, you will probably need medication. You will still need to make changes to your diet and exercise habits, even if your doctor prescribes medication.
Several medications are available to treat high blood pressure. Ten percent of people with hypertension may need as many as three drugs to control their condition.
Some of the most commonly prescribed medications include:
Diuretics help the kidneys eliminate sodium and water from the body. This lowers the amount of blood in the body and brings down blood pressure.
There are three types of diuretics: thiazide, loop, and potassium-sparing.
Other medications used to treat hypertension include:
Beta blockers: Slow down the heart rate, reducing how hard your heart has to work. They also reduce stress hormones in the body, which allows blood vessels to relax. Beta blockers are not as effective in African-Americans, but they do work when taken with a thiazide diuretic. Beta blockers include:
Angiotensin-converting enzyme (ACE) inhibitors: Block your body from making the chemical angiotensin, which helps stop blood vessels from narrowing. As blood vessels relax, blood pressure goes down. Like beta blockers, ACE inhibitors alone do not work as well in African-Americans, but do work when combined with a thiazide diuretic. ACE inhibitors include:
Calcium-channel blockers (CCBs): Relax blood vessels and lower blood pressure by stopping calcium from getting into heart cells and arteries. Side effects may include constipation, nausea, and headache. Grapefruit juice interacts with some calcium-channel blockers, so DO NOT drink it if you take these drugs. CCBs include:
Angiotensin II receptor blockers (ARBs): Block the effects of the chemical angiotensin in the body, lowering blood pressure. ARBs are sometimes used when a person cannot take ACE inhibitors. These drugs include:
Complementary and Alternative Therapies
Whether or not your doctor prescribes medication to lower your blood pressure, you need to make changes in your diet and lifestyle. Your treatment plan may also include a range of complementary and alternative therapies (CAM). Ask your doctor how to incorporate these therapies into your overall treatment plan.
DO NOT stop taking your medication without your doctor's supervision. Quickly stopping some types of blood pressure medications can cause blood pressure to rise extremely high, which could cause stroke, heart attack, or other medical complications. Always tell your health care provider about the herbs and supplements you are using or considering using.
The following lifestyle changes will help treat high blood pressure:
Nutrition and Dietary Supplements
Eating a healthy diet that is low in saturated fat and salt can help lower blood pressure. Following these nutritional tips may help:
Some vitamins and supplements may help lower blood pressure, although scientific evidence is mixed. Be sure to talk to your doctor before taking any vitamins or supplements, especially if you take medicine for high blood pressure.
Herbs may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.
Talk to your doctor before taking any herbs to treat hypertension, especially if you already take medication to control blood pressure.
Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for hypertension based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular person.
Several studies suggest the using acupuncture helps lower blood pressure. More research is needed.
Massage and Physical Therapy
Massage may help people with high blood pressure cope with stress. One study found that people with hypertension who got massage had lower blood pressure and steroid hormones, an indicator of stress. People with hypertension who tend to have high levels of stress may be helped by massage therapy.
The association between stress and hypertension is complicated and somewhat controversial. The best evidence of a relaxation technique that reduces blood pressure is for transcendental meditation (TM). Several studies also say that yoga may help lower blood pressure.
Your doctor will check your blood pressure often while you are pregnant. Some women get hypertension for the first time during pregnancy. If this happens, you may need medication. Preeclampsia, which involves high blood pressure during pregnancy, can be life threatening. In preeclampsia, high blood pressure happens along with other symptoms, such as swelling of the ankles and legs, blurred vision, liver test abnormalities, and protein in the urine.
Warnings and Precautions
Prognosis and Complications
If not treated, hypertension can cause serious complications, including:
Fortunately, there are several treatment options for hypertension. Comprehensive treatment, including lifestyle changes and blood pressure medications, usually controls high blood pressure and results in a good prognosis.
Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. 2006;100(4):1164-70.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.
Cevik C, Iseri SO. The effect of acupuncture on high blood pressure of patients using antihypertensive drugs. Acupunct Electrother Res. 2013;38(1-2):1-15.
de Souza RJ, Swain JF, Appel LJ, Sacks FM. Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations. Am J Clin Nutr. 2008 Jul;88(1):1-11.
Diaz Encarnacion MM, Warner GM, Gray CE, Cheng J, Keryakos HK, Nath KA, Grande JP. Signaling pathways modulated by fish oil in salt-sensitive hypertension. Am J Physiol Renal Physiol. 2008 Jun;294(6):F1323-35.
Dickinson HO, Campbell F, Beyer FR, Nicolson DJ, Cook JV, Ford GA, Mason JM. Relaxation therapies for the management of primary hypertension in adults: a Cochrane review. J Hum Hypertens. 2008 Jun 12. (Epub ahead of print)
Edwards T. Inflammation, pain, and chronic disease: an integrative approach to treatment and prevention. Altern Ther Health Med. 2005;11(6):20-7; quiz 28, 75.
Esposito K, Ciotola M, Giugliano D. Mediterranean diet and the metabolic syndrome. Mol Nutr Food Res. 2007 Oct;51(10):1268-74. Review.
Ferri: Ferri's Clincial Advisor 2015. 1st ed. Phildalephia, PA: Elsevier Mosby; 2014.
Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med. 2000;30:193-206.
Hernandez-Reif M, Field T, Krasnegor J, Theakston H, Hossain Z, Burman I. High blood pressure and associated symptoms were reduced by massage therapy. J Bodywork Movement Ther. 2000;4:31-38.
Huang HY, Caballero B, Chang S, et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med. 2006;145(5):372-85.
Jung UJ, Torrejon C, Tighe AP, Deckelbaum RJ. n-3 Fatty acids and cardiovascular disease: mechanisms underlying beneficial effects. Am J Clin Nutr. 2008 Jun;87(6):2003S-9S.
Khan AU, Gilani AH. Blood pressure lowering, cardiovascular inhibitory and bronchodilatory actions of Achillea millefolium. Phytother Res. 2010 Sep 20. (Epub ahead of print)
Kendler BS. Supplemental conditionally essential nutrients in cardiovascular disease therapy. J Cardiovasc Nurs. 2006;21(1):9-16.
Kokkinos PF, Papademetriou V. Exercise and hypertension. Coronary Artery Dis. 2000;11:99-102.
Kozuma K, Tsuchiya S, Kohori J, et al. Antihypertensive effect of green coffee bean extract on mildly hypertensive subjects. Hypertens Res. 2005 Sep;28(9):711-8.
Kunutsor SK, Burgess S, Munroe PB, Khan H. Vitamin D and high blood pressure: causal association or epiphenomenon? Eur J Epidemiol. 2014;29(1):1-14.
Lane JS, Magno CP, Lane KT, Chan T, Hoyt DB, Greenfield S. Nutrition impacts the prevalence of peripheral arterial disease in the United States. J Vasc Surg. 2008 Jun 27. (Epub ahead of print)
Miura K, Stamler J, Nakagawa H, Elliott P, Ueshima H, Chan Q, et al; International Study of Macro-Micronutrients and Blood Pressure Research Group. Relationship of dietary linoleic acid to blood pressure. The International Study of Macro-Micronutrients and Blood Pressure Study. Hypertension. 2008 Aug;52(2):408-14. Erratum in: Hypertension. 2008 Sep;52(3):e29.
Pratt C. Alternative prevention and treatment of cardiovascular disease, part 2. Prim Care. 2010 Jun;37(2):339-66. Review.
Ried K, Frank OR, Stocks NP, Fakler P, Sullivan T. Effect of garlic on blood pressure: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2008 Jun 16;8:13. Review.
Rosanoff A, Plesset MR. Oral magnesium supplements decrease high blood pressure (SBP>155 mmHg) in hypertensive subjects on anti-hypertensive medications: a targeted meta-analysis. Magnes Res. 2013; 26(3):93-9.
Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.
Sacks FM, Svetkey LP, Volmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. N Engl J Med. 2001;344:3-10.
Scheffler A, Rauwald HW, Kampa B, Mann U, Mohr FW, Dhein S. Olea europaea leaf extract exerts L-type Ca(2+) channel antagonistic effects. J Ethnopharmacol. 2008 Aug 23. (Epub ahead of print)
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.
Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.
Watanabe T, Arai Y, Mitsui Y, et al. The blood pressure-lowering effect and safety of chlorogenic acid from green coffee bean extract in essential hypertension. Clin Exp Hypertens. 2006;28:439-49.
Wu SH, Ho SC, Zhong L. Effects of vitamin D supplementation on blood pressure. South Med J. 2010 Aug;103(8):729-37.
Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.
Yang H, Kenny A. The role of fish oil in hypertension. Conn Med. 2007 Oct;71(9):533-8. Review.
Review Date: 3/23/2015
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.