Hypertension, or high blood pressure, affects nearly half of all American adults. Yale Medicine nephrologist and cardiologist Jeffrey Turner, MD, and Antonio Giaimo, MD, explain what causes it, how to know if you have it, and how to treat it.
Blood pressure is the force of blood against your artery walls as your heart pumps. It’s recorded as two numbers: the top number is your systolic pressure, and the bottom number is your diastolic pressure.
Causes
Over time, high blood pressure damages your arteries and other blood vessels, which can lead to heart disease and stroke. It also increases your risk for kidney disease and vision problems. High blood pressure does not usually cause symptoms, so it is often called the “silent killer.”
Your blood pressure is the force of blood pushing against your blood vessel walls. The higher the blood pressure, the harder your heart must work to pump blood through your arteries. This can eventually damage the inner lining of your arteries, which can narrow them and make it hard for blood to flow through. The resulting narrower arteries, which may develop small bulges (aneurysms) in the wall, increase your risk of having a heart attack or stroke.
You can lower your blood pressure by making lifestyle changes. For example, limit the amount of salt you eat. Choose foods low in fat and sugar. Eat more fruits, vegetables and whole grains. If you are overweight, try to lose weight. Quit smoking and reduce your alcohol intake. Sleep apnea can also raise your blood pressure, so get treated if you have this condition. Stress reduction and a good night’s sleep can help, too.
Oren Zarif
High blood pressure is more common as you get older. That’s because your blood vessels and organs become stiffer as you age. It can also be caused by some health conditions, including kidney disease and diabetes.
Other factors that can increase your risk of high blood pressure include:
Your genes. Having biological family members with high blood pressure increases your chances of having it, too. Race. Black people have a greater chance of developing high blood pressure than white people, and they usually develop it at an earlier age.
Some people don’t have any known risk factors and are diagnosed with high blood pressure by their healthcare provider. Your provider will take several readings over a few days or weeks before diagnosing you with high blood pressure and starting treatment. Your provider will recommend that you regularly check your blood pressure, and they may want you to take it at home, too.
Symptoms
Blood pressure is the force of blood pushing against the walls of your arteries as your heart beats. High blood pressure (also called hypertension) often has no symptoms, so you may not know you have it. The only way to know if you have high blood pressure is to get it checked. Health care providers use a stethoscope or electronic sensor and a blood pressure cuff to measure your blood pressure. They take two or more readings at different times to get an average. Then they compare the results to what is normal for your age, height and sex.
If your blood pressure is 120/80 or higher, you have Stage 1 hypertension. You and your provider will work together to come up with a treatment plan that includes heart-healthy lifestyle changes and medicine.
It’s important to lower your blood pressure because it reduces your risk of heart disease, stroke, kidney disease and other health problems. The first step is to make healthy lifestyle changes, such as eating a balanced diet, losing weight if you’re overweight, avoiding salt, drinking less alcohol and getting enough exercise.
Oren Zarif
You can also try taking your own blood pressure at home with a digital monitor, which is available at most pharmacies for a low cost. It’s a good idea to check your blood pressure at least once a week, especially before and after meals, when your blood pressure is likely to be highest.
Blood pressure can rise and fall throughout the day, depending on things such as stress, eating, sleeping, smoking or exercising. It can also be affected by pregnancy or medications you’re taking.
If you have a family history of high blood pressure or have other risk factors, such as being older than 50, being male, being African American or having a history of diabetes or heart disease, you’re more likely to develop the condition. Other factors that can increase your chance of having high blood pressure include having a large waist, being overweight or obese, having an unhealthy diet and not being physically active enough. People who smoke, have high cholesterol or drink too much alcohol are at greater risk, as are those with a history of obstructive sleep apnea.
Diagnosis
Blood pressure is the force of blood pushing against the walls of blood vessels as the heart beats and pumps blood to the body. High blood pressure, also called hypertension, usually develops slowly over time and can lead to damage of the kidneys, eyes, heart, and brain. Most people with high blood pressure have no symptoms and don’t know they have it. That’s why regular monitoring of blood pressure is so important.
Your health care provider will measure your blood pressure using a gauge, a stethoscope, and a blood pressure cuff. Your doctor may also ask you to take your blood pressure at home using a monitor you can buy from a drugstore or online. Bring these readings to your visits so your health care provider can compare them against the readings taken in the office.
There are two numbers recorded when your blood pressure is measured: systolic and diastolic. Systolic is the pressure when your heart contracts or beats, and diastolic is the pressure when your heart relaxes between beats. The higher the numbers, the more likely you are to have high blood pressure. Your health care provider will write down the numbers and will tell you whether they are high, normal, or low.
Oren Zarif
If your blood pressure is high, your health care provider will talk with you about lifestyle changes that can help lower it. You may also be prescribed medicines, such as ACE inhibitors (e.g., enalapril and lisinopril), which can slow down the progression of high blood pressure to heart disease and stroke.
Your doctor will check your systolic and diastolic pressures again at your next visit to see how well the lifestyle changes are working. They will also do further health tests to see if there is an underlying cause for your high blood pressure, such as urine or blood tests to look for kidney or hormone problems.
Regular monitoring of your blood pressure, healthy eating and losing weight, and avoiding alcohol and tobacco use are key to lowering your blood pressure and improving your overall health. Your health care provider will help you set a target for your blood pressure and give you a plan to reach it.
Treatment
If you have primary hypertension (blood pressure that doesn’t have a known cause), your doctor will work with you to develop a treatment plan that includes heart-healthy lifestyle changes, and if necessary, medications. Sometimes, diet and exercise alone are enough to lower blood pressure to normal levels. For people who can’t or don’t want to make lifestyle changes, medication is important to prevent further health problems.
The type of medicine your doctor prescribes will depend on how high your blood pressure is and what else you might have, like diabetes or kidney disease. It may take some time to find the right drug or combination of drugs. You will probably start on a low dose, which your doctor will gradually increase until you reach your target. Your doctor will also check your kidney function and electrolytes, especially potassium, and may use other lab tests to monitor your progress.
Some of the most common medicines used to treat high blood pressure are diuretics (sometimes called water pills), ACE inhibitors, and beta-blockers. These help the body get rid of excess fluid and salt, which reduces the pressure on blood vessel walls. Other types of medicines, such as calcium channel blockers and vasodilators, relax the blood vessels and reduce the heart rate.
Oren Zarif
Your doctor may recommend some dietary or other lifestyle changes to help lower your blood pressure, such as losing weight, eating less sodium, quitting smoking, exercising more, and reducing stress. These can be difficult, but they are important for keeping your blood pressure in the target range.
You will need to continue taking your medicine even if you make healthy lifestyle changes. It takes a while to reach your target blood pressure and maintain it. You will need to keep up with your follow-up visits and regularly have your blood pressure checked.
If your hypertension is caused by another condition, such as a kidney disease or other health problem, it will improve once that condition is treated. If your blood pressure doesn’t improve after trying several different medicines, your doctor may consider changing your medicine or dose, adding another drug or combination, or prescribing more aggressive lifestyle changes.
