Hypertension

High blood pressure affects nearly half of all adults in the United States and about 1.4 billion people worldwide, yet many don’t even know they have it because it usually causes no symptoms. This silent condition can lead to serious health problems like heart attack, stroke, and kidney disease, but the good news is that lifestyle changes and proper treatment can help keep it under control.

Table of contents

• What is hypertension?
• How common is high blood pressure?
• Understanding blood pressure numbers
• Blood pressure categories
• Signs and symptoms
• What causes high blood pressure?
• Risk factors
• Health complications
• How is hypertension diagnosed?
• Treatment options
• Lifestyle changes to manage blood pressure
• Blood pressure medications
• Living with hypertension

What is hypertension?

Hypertension, commonly known as high blood pressure, is a condition where the force of blood pushing against your artery walls is consistently too high^[1]. Arteries are blood vessels that carry blood from your heart to other parts of your body^[4].

When you have high blood pressure, your heart has to work harder to pump blood through your body. This makes your heart work overtime, putting extra stress on both your heart and blood vessels^[5]. Over time, this constant pressure damages your arteries and heart, potentially leading to serious complications^[5].

Because high blood pressure usually doesn’t cause symptoms, it’s often known as a “silent killer”^[5]. The only way to know if you have it is to get your blood pressure checked regularly^[2].

How common is high blood pressure?

High blood pressure is very common. It affects nearly half of all adults in the United States^[5]. Worldwide, an estimated 1.4 billion adults aged 30 to 79 years had hypertension in 2024, representing 33% of the population in this age range^[2].

Two-thirds of adults aged 30 to 79 years who have hypertension live in low- and middle-income countries^[2]. Alarmingly, an estimated 600 million adults with hypertension (44%) are unaware that they have the condition^[2]. The World Health Organization estimates that 46% of adults with hypertension don’t know they have it^[5].

Over 70 percent of people age 60 and older have high blood pressure^[9]. For people age 75 and older, the percentage rises to 81 percent for women and 73 percent for men^[9]. Black people have a higher rate of hypertension than any other racial or ethnic group^[9].

Understanding blood pressure numbers

Blood pressure is measured in millimeters of mercury (mm Hg)^[1]. Your reading has two numbers^[5]:

• Systolic blood pressure: This is the top number. It represents the pressure in your blood vessels when your heart contracts or beats. It’s the pressure on your artery walls when your heart pumps blood out^[5][6].
• Diastolic blood pressure: This is the bottom number. It represents the pressure in the vessels when your heart rests between beats. It’s the pressure between heartbeats when your heart is filling with blood^[2][6].

Blood pressure is written as two numbers separated by a slash, like 120/80 mm Hg. You can say this as “120 over 80 millimeters of mercury” or just as “120 over 80”^[6].

Your blood pressure changes throughout the day based on your activities^[4][6]. Having blood pressure consistently above normal may result in a diagnosis of high blood pressure^[4].

Blood pressure categories

In the United States, the American College of Cardiology and the American Heart Association divide blood pressure into four general categories^[1]:

• Normal blood pressure: Blood pressure is less than 120/80 mm Hg^[1][6].
• Elevated blood pressure: The top number ranges from 120 to 129 mm Hg and the bottom number is below 80 mm Hg^[1].
• Stage 1 hypertension: The top number ranges from 130 to 139 mm Hg or the bottom number is between 80 and 89 mm Hg^[1].
• Stage 2 hypertension: The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher^[1].

In general, hypertension is a blood pressure reading of 130/80 mm Hg or higher^[1]. Blood pressure higher than 180/120 mm Hg is considered a hypertensive emergency or crisis and requires immediate emergency medical help^[1].

Hypertension is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is 140 mmHg or higher, and/or the diastolic blood pressure readings on both days is 90 mmHg or higher^[2].

Signs and symptoms

Most people with hypertension don’t feel any symptoms^[2]. High blood pressure usually has no warning signs or symptoms, and many people do not know they have it^[4]. You could have it for years without feeling any clues^[5].

Measuring your blood pressure is the only way to know whether you have high blood pressure^[4]. Sometimes there’s an assumption that if you feel well, you’re generally healthy. But you can feel very well for a long time and not know you have significant high blood pressure that’s damaging your body^[19].

If your blood pressure is extremely high, you may have symptoms like^[5]:

• Changes to your mental function
• Chest pain
• Dizziness
• Edema (swelling)
• Heart palpitations
• Peeing less than usual
• Seizures
• Severe headache
• Signs of stroke, like sudden facial droop, slurred speech or sudden arm/leg weakness
• Vision changes, like eye pain, vision loss or sudden blurry vision

Very high blood pressures can also cause headaches, blurred vision, and other symptoms^[2]. This is called a hypertensive emergency. If your blood pressure is 180/120 or higher and you have any of the symptoms above, call 911 or your local emergency services number right away^[5].

What causes high blood pressure?

Healthcare providers can’t find a single cause of hypertension for most people. Instead, many factors can come together to make your blood pressure higher^[5].

There are two main types of high blood pressure, based on what’s causing it^[5]:

• Primary hypertension: This means your genetics, family history and age are the primary causes of your high blood pressure. This is the most common type^[5].
• Secondary hypertension: This means there’s an identifiable cause, like a medical condition, medication or addictive substance, that is making your blood pressure high. It usually gets better after you treat that condition or stop taking the medicines that are causing it^[5][7].

High blood pressure usually develops over time. It can occur because of unhealthy lifestyle choices, such as not getting enough regular physical activity^[4].

Risk factors

Things that increase the risk of having high blood pressure include^[2]:

• Older age
• Genetics and family history
• Being overweight or obese
• Not being physically active
• High-salt diet
• Drinking too much alcohol

Several factors contribute to hypertension. These include being over age 55, having a history of the condition in your biological family, smoking or using tobacco products, having overweight or obesity, eating foods high in sodium, not getting enough physical activity, and drinking too much alcohol^[5].

Modifiable risk factors include unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco and alcohol, and being overweight or obese^[2]. In addition, there are environmental risk factors for hypertension and associated diseases, where air pollution is the most significant^[2].

Non-modifiable risk factors include a family history of hypertension, age over 65 years and co-existing diseases such as diabetes or kidney disease^[2].

Americans have a salt problem. The challenge in the U.S., in particular, is that many of the processed foods we buy have tons of salt in them. This excess sodium leads to excess fluid and volume in the blood vessels, which causes blood pressure to rise. Beyond that, a high-sodium diet combined with a sedentary lifestyle is likely also contributing to the obesity epidemic, and the extra weight can also raise blood pressure^[19].

Health complications

Untreated, high blood pressure increases the risk of heart attack, stroke and other serious health problems^[1]. When hypertension goes untreated, the ongoing pressure damages your arteries and puts excessive stress on your heart^[20].

Hypertension is a major cause of premature death worldwide^[2]. The higher your blood pressure levels, the more risk you have for other health problems, such as heart disease, heart attack, and stroke^[4].

The condition forces the heart to work harder, which can lead to serious problems^[19]. As a result, hypertension is a leading cause of^[20]:

• Heart attacks
• Heart failure
• Aneurysms
• Strokes
• Peripheral artery disease
• Carotid artery disease
• Coronary artery disease
• Vascular dementia
• Vision loss
• Chronic kidney disease

Among the problems high blood pressure can cause or make worse are peripheral edema (buildup of fluids usually in the ankles, feet, lower legs, hands, arms, and lungs), pulmonary edema (fluid buildup in the lungs making it difficult to breathe), vascular ulcers (skin sores that can appear in the feet, lower legs, or calves), and heart failure, which is the main cause of illness and death associated with hypertension. In older adults, about 70 percent of all heart failure cases are caused by high blood pressure^[9].

There is also a subtype of dementia called vascular dementia, which is much more prevalent in patients with high blood pressure. The thought is that high blood pressure contributes to blockages in small blood vessels of the brain, injuring it. That, over time, can lead to dementia^[19].

How is hypertension diagnosed?

Your health care team can diagnose high blood pressure by measuring your blood pressure^[4]. They will use a gauge, a stethoscope or electronic sensor, and a blood pressure cuff^[7].

They will take two or more readings at separate appointments before making a diagnosis^[7]. Because hypertension involves consistently high blood pressure readings over time, one or two readings alone might not be helpful^[19].

The best way to know if you have it is to monitor your blood pressure over time, either at annual physicals in the doctor’s office or at home, using your own blood pressure cuff^[19].

It’s important to have your blood pressure checked at least every two years starting at age 18. Some people need more-frequent checks^[1].

Treatment options

For most people with high blood pressure, a healthcare provider will work with you to develop a treatment plan that may include heart-healthy lifestyle changes alone or with medicines^[11][18].

Treatments for high blood pressure include heart-healthy lifestyle changes and medicines. You will work with your provider to come up with a treatment plan. It may include only the lifestyle changes. These changes, such as heart-healthy eating and exercise, can be very effective. But sometimes the changes do not control or lower your high blood pressure. Then you may need to take medicine. There are different types of blood pressure medicines. Some people need to take more than one type^[7].

Your provider can help you manage your blood pressure and prevent complications. They may use a risk calculator to estimate your risk of complications and guide a discussion with you about choosing the best treatments^[11][18].

Your provider may also involve other experts in your treatment, including a nutritionist or dietician, a pharmacist, and specialists for other conditions you have, including heart conditions^[11][18].

If your high blood pressure is caused by another medical condition or medicine, it may get better once the cause is treated or removed^[7][11][18]. Research suggests that getting your systolic blood pressure below 120 mm Hg can reduce your risk of serious complications^[11][18].

Finding and treating high blood pressure can prevent heart attacks, strokes, problems with thinking and memory, kidney disease, eye disease, and other serious problems^[9]. You can significantly lower your risk or prevent these health problems by getting your blood pressure down to normal and keeping it there^[20].

Lifestyle changes to manage blood pressure

Healthy lifestyle habits can help prevent and treat high blood pressure^[1]. Lifestyle changes like eating a healthier diet, quitting tobacco and being more active can help lower blood pressure^[2].

Controlling blood pressure with a healthy lifestyle might prevent, delay or lessen the need for medicine^[12][15]. By making lifestyle changes, you can help keep your blood pressure levels healthy^[17].

Depending on your current habits, you may need to gradually adjust your diet, increase your daily activity, lose weight, stop smoking, or reduce stress^[20].

Lose extra weight and watch your waistline

Weight loss is one of the best ways to control blood pressure. If you’re overweight or have obesity, losing even a small amount of weight can help lower blood pressure^[12][15]. Blood pressure often increases as weight increases^[12][15].

In general, blood pressure might go down by about 1 mm Hg with each kilogram (about 2.2 pounds) of weight lost^[12][15]. Even losing as little as seven to 10 pounds can lower your blood pressure^[21].

Carrying too much weight around the waist can raise the risk of high blood pressure. In general, men are at risk if their waist measurement is greater than 40 inches (102 centimeters), and women are at risk if their waist measurement is greater than 35 inches (89 centimeters)^[12][15].

Exercise regularly

Staying physically active is one of the best things you can do for your health^[8]. Physical activity helps keep your heart and blood vessels strong. It also can help you keep a healthy weight^[20].

Regular aerobic exercise can lower high blood pressure^[12][15]. Exercise lowers your blood pressure by strengthening your heart and blood vessels^[20].

If you have hypertension, you can work to control your blood pressure by exercising for 30 minutes a day, at least five days a week^[8]. You don’t need to jump into an intensive exercise routine or join a gym. Moderate activities like walking, dancing, and cycling make a big difference, as long as you do them on a regular basis^[20].

You can even break it up into 10-minute periods of exercise throughout the day if that works better for you. Short walks are another great way to get started. Gradually, you can build up to more endurance to walk farther or go at faster pace^[8].

Eat healthy foods and limit sodium

Choosing healthy meal and snack options can help you avoid high blood pressure and its complications. Be sure to eat plenty of fresh fruits and vegetables^[17].

The amount of salt you consume directly impacts your blood pressure. Reducing the salt in your diet isn’t just essential, it’s also one of the quickest ways to lower your blood pressure^[20]. Americans eat far too much dietary sodium, up to three times the recommended total amount, which is 1,500 milligrams (mg) daily for individuals with high blood pressure^[21].

The American Heart Association recommends limiting sodium to 2,300 milligrams (mg) daily and says most adults should move toward an ideal limit of 1,500 mg per day^[8].

Though you may need to cut back on the amount of salt you add to your food, most dietary salt comes from prepared foods. That means it’s important to lower the amount of salt you get from things like restaurant fare, canned foods, cold cuts, bread, and pizza^[20]. It’s very difficult to lower dietary sodium without reading labels, unless you prepare all of your own food^[21].

On the other hand, potassium offsets the effect of salt and lowers your blood pressure. You can get potassium from a variety of fruits and vegetables, including leafy greens^[20]. Beets, berries, spinach, tomatoes and bananas are great examples of potassium-rich foods^[22].

Eating patterns that are proven to help include the DASH (Dietary Approaches to Stop Hypertension) diet. Similarly, the Mediterranean diet has been studied to prove its positive impact on overall cardiovascular health^[22].

Load up on fruits, vegetables and whole grains

Countless studies show that loading up on fruits and veggies protects against cancer, heart disease, diabetes and stroke. These nutrient-rich gems are loaded with antioxidant and anti-inflammatory compounds. To get the most nutrient bang out of your produce, be sure to choose a rainbow of colors. In addition, fruits and vegetables are natural sources of potassium, which is crucial for managing blood pressure^[22].

Packed with fiber, whole grains not only help keep cravings in check, they also amp up the flavor in your favorite recipes. Research shows that eating a diet rich in whole grains (such as quinoa and other ancient grains, oatmeal and brown rice) helps fend off heart disease, high blood pressure, diabetes and some forms of cancer^[22].

Stop smoking

When you smoke, your blood pressure temporarily increases. Additionally, the chemicals in cigarette smoke damage your heart and blood vessels. Any amount of smoking, including an occasional cigarette and breathing second-hand smoke, increases your risk of cardiovascular disease^[20]. Do not smoke. Smoking damages your blood vessels and greatly increases your risk of not only high blood pressure but also heart disease, heart attack, and stroke^[17].

Limit alcohol to one drink per day

Drinking too much, too often, can raise your blood pressure. It’s important to limit alcohol to one drink per day^[21].

Manage stress

When you’re under stress, your body releases hormones that tighten your blood vessels and raise your heart rate, changes that contribute to hypertension. Though stress alone may not cause hypertension, reducing stress goes a long way toward lowering your blood pressure^[20].

It’s difficult to pin down the exact relationship between stress and hypertension. But we know when we look at population studies that include large groups of patients that certain stressors worsen cardiovascular disease as a whole. We’re talking about things like financial burdens and living in communities where people feel marginalized. Loneliness is also a contributor^[19].

Blood pressure medications

Some people may still need to take medicines^[1]. Medication can’t do its job if you don’t take the proper dose. Yet 40% of people fail to take their prescribed antihypertensive medications^[20].

The medications that are used to treat hypertension do one of three things: relax the heart from pumping so hard, allow the kidneys to let out some fluid (so there is less fluid to pump), or relax the arteries. Sometimes, medications will do a combination of these things. For example, your doctor may prescribe medications that allow for both your heart and arteries to relax. This can help blood flow more easily throughout your body^[8].

There are different types of blood pressure medicines. Some people need to take more than one type^[7]. If you have severe hypertension, you may also need to take medications^[20].

Living with hypertension

After you’re diagnosed with hypertension, most aspects of your life won’t change^[20]. Most people need to make life adjustments after they develop hypertension. The reason is simple: Lifestyle changes and medications are the only treatments. Your daily habits have such an impact that lifestyle changes alone may get your blood pressure back to normal^[20].

Whether you face big changes or only need to make a few minor adjustments, one thing is certain: The life adjustments can treat your hypertension and add years to your life^[20].

Measure your blood pressure regularly

Measuring your blood pressure on a regular basis is an important step toward keeping a healthy blood pressure. High blood pressure often has no symptoms. Checking your blood pressure is the only way to know for sure whether it is too high. If you learn that you have high blood pressure, you should take steps to control your blood pressure. This will lower your risk for heart disease and stroke^[17].

Manage related health conditions

Most people with diabetes (about 6 out of 10) also have high blood pressure. If your health care professional thinks you have symptoms of diabetes, he or she may recommend that you get tested. If you have diabetes, it’s important to stick to your treatment plan to keep your blood sugar (glucose) levels within the target range set by your doctor. Living well with diabetes also means taking your medicines as prescribed, eating well, and getting regular physical activity. These actions can also help reduce your risk for high blood pressure^[17].

Having overweight or obesity means your heart must work harder to pump blood and oxygen around the body. Staying at a healthy weight reduces the stress on your heart and reduces your risk for heart disease, heart attack, and stroke^[17].

People who have depression, anxiety, stress, or post-traumatic stress disorder over a long period of time may develop other health problems, including an increased heart rate and high blood pressure. Recognize the signs and symptoms of mental health disorders and heart disease. Talk with your health care team about potential heart conditions in relation to your mental health^[17].

The person with hypertension and their healthcare professional need to find a blood pressure goal that works. For example, older adults with heart disease or some circulation problems have better outcomes with a lower systolic blood pressure goal of 120 mmHg or less without increasing the risk of falls. Frail adults, including residents in long term care facilities, need to avoid lowering their blood pressure too much. This can cause falls and fainting^[9].

Many people are able to control their blood pressure with diet and exercise. But it is important to be realistic. If you are doing the most you can with diet and exercise, but your blood pressure is still high, you should talk with your doctor^[8].