Hypertension — aka high blood pressure — occurs when the heart generates too much pressure in the blood vessels. It affects half of American adults, but it often has no symptoms. Untreated hypertension can lead to stroke, heart attack, and heart disease, so it’s important to get your blood pressure checked regularly.
Hypertension is a very common condition, affecting about half of all adults in the U.S. But it doesn’t always have symptoms, so about one in three people don’t know they have it.
Hypertension develops when the force of the blood coming from your heart consistently puts too much pressure on the walls of your arteries. Over time, this pressure can cause small tears in your arteries. Plaque can collect in and around these tears, causing your arteries to narrow and obstructing the flow of blood to and from your heart.
When plaque builds up inside your arteries, it can further increase your blood pressure and increase your risk of heart disease.
When you have high blood pressure, your heart has to work harder to move blood through your body. This puts strain on your heart muscle and can lead to problems like heart attack and heart failure.
Without proper treatment, hypertension can lead to:
Atherosclerosis (a buildup of plaque in your arteries)
Stroke
Cardiovascular disease
Heart failure
Heart attack
Eye damage
Kidney failure
Vascular dementia
Aneurysm
Doctors sometimes call hypertension the “silent killer,” because people don’t typically notice it until it starts causing health problems.
You might only experience high blood pressure symptoms if your blood pressure is very high.
Very high blood pressure can cause symptoms like:
Nosebleeds
Anxiety
Severe headaches
Chest pain
Dizziness
Vision changes
Buzzing in the ears
There are many different causes of high blood pressure, but often one single cause isn’t found. When this happens, it’s known as essential hypertension or primary hypertension.
High blood pressure can be caused by a combination of lifestyle factors like:
Having overweight or obesity
Eating unhealthy foods, especially salty foods
Not getting enough exercise
Not getting enough sleep
Drinking too much alcohol
Smoking
Experiencing a lot of stress
When a medical condition or medication causes high blood pressure, it’s known as secondary hypertension.
Secondary hypertension can be caused by:
Sleep apnea
Problems with your adrenal glands
Chronic kidney disease
Renal artery stenosis (when the artery leading to your kidney is narrowed)
Medications like cold medications
There are many hypertension risk factors. Some, we have control over, others we have no say in.
Risk factors we have some control over include:
Eating an unhealthy diet (high in salty or processed foods)
Not exercising regularly
Drinking too much alcohol
Smoking
Stress
Not getting enough sleep
Living with overweight or obesity
Risk factors we don’t have control over include:
Age. Our blood vessels thicken and stiffen as we age, which can lead to higher blood pressure.
Genetics. If you have a family member with high blood pressure, you’re at increased risk of developing high blood pressure. Genetics can also affect how sensitive you are to the salt in your diet.
Medical conditions. Some medical conditions can increase your odds of high blood pressure. These include sleep apnea, diabetes, high cholesterol, thyroid problems, and chronic kidney disease.
Medications. Medications that can raise your blood pressure include antidepressants, birth control pills, decongestants, and non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and aspirin.
Race. You have a higher risk of high blood pressure if you’re Black.
Sex. Men have a higher risk of high blood pressure than women in middle age, but women have a higher risk than men in older age.
The only way to find out if you have high blood pressure is to check your blood pressure with a blood pressure monitor. You should get your blood pressure checked at least once a year to make sure it’s within a healthy range.
You can get tested by a healthcare professional in a doctor’s office, clinic, or pharmacy. You can also buy an easy-to-use blood pressure cuff at a pharmacy or online retailer.
Blood pressure tests are quick and painless.
Before you test your blood pressure:
Avoid coffee, exercise, and cigarettes for 30 minutes
Go to the bathroom
Relax and sit down for five minutes before testing
Try — as best as possible — not to get too excited or nervous. This can increase your blood pressure and affect your reading.
During the test, a healthcare provider will put a blood pressure cuff around your upper arm. The cuff is connected to a small machine.
The cuff will inflate with air, and you’ll feel some pressure around your arm. After a few seconds, the cuff will deflate, and you’ll see your blood pressure reading on the machine.
Your healthcare provider may repeat the test a few times and check your blood pressure at different appointments before diagnosing you with high blood pressure.
They may also recommend an at-home test. There is a phenomenon known as “white coat hypertension” that can occur when your blood pressure is higher in a doctor’s office than it is at home — often do to stress or nerves. An at-home test can help get a more accurate reading.
Blood pressure is measured with two numbers, measured in millimeters of mercury (mm Hg).
The first number — the top number — is your systolic blood pressure. This is the pressure of your blood against your artery walls when blood is pumped out of your heart.
The second number — the bottom number — is your diastolic blood pressure. This is the pressure of your blood against your artery walls back toward the heart, in between heartbeats.
You have hypertension when you consistently have:
A systolic blood pressure at or above 130 mm Hg
A diastolic blood pressure at or above 80 mm Hg
Here’s a full breakdown of blood pressure readings:
Systolic (mm Hg) | Diastolic (mm Hg) | |
|---|---|---|
Normal Blood Pressure | less than 120 | less than 80 |
Elevated blood pressure | 120 to 129 | less than 80 |
Hypertension stage 1 | 130 to 139 | 80 to 89 |
Hypertension stage 2 | 140 or higher | 90 or higher |
Hypertensive crisis | 180 or higher | 120 or higher |
If you’ve checked your blood pressure and the reading indicates a hypertensive crisis, wait five minutes and then check it again. If it’s still high, contact your healthcare provider immediately.
Call 911 if your reading indicates a hypertensive crisis and you’re experiencing any of the following symptoms:
Shortness of breath
Chest pain
Difficulty speaking
Numbness
Weakness
Back pain
Changes in vision
A sudden, severe headache
If your healthcare provider finds you have high blood pressure, they may recommend further testing to determine what’s causing it or to find out whether it’s damaged your organs.
They may test for:
High cholesterol
Kidney disease
Heart disease
They may also do a physical exam and ask about your symptoms, medical history, and family history. This can help them recommend the best treatment plan for you.
Your provider might recommend home blood pressure monitoring or have you come in for regular checkups.
The treatment for hypertension will depend on how high your blood pressure is and what’s causing it.
For example, elevated blood pressure and hypertension stage 1 may require some lifestyle changes. If you have hypertension stage 2, on the other hand, you may need medication alongside lifestyle changes.
The treatment of hypertension often includes:
Eating heart-healthy foods. These include fruits, vegetables, whole grains, and low-fat dairy products. Your healthcare provider might recommend the DASH eating plan (Dietary Approaches to Stop Hypertension). This includes eating heart-healthy foods and limiting how much salt you eat.
Quitting smoking. Your provider can instruct you on the best way to quit. They may recommend smoking cessation resources like nicotine patches or gum, support groups, or prescription medications that help you quit.
Getting active. Try incorporating more movement into your week, including walking, jogging, swimming, standing, and general physical activity.
Losing weight. Losing three to five percent of your body weight — or more — can help reduce your blood pressure.
Getting more sleep. Aim for at least seven hours of shut-eye each night. Keeping a regular sleep schedule, winding down before bed, and cutting back on caffeine can help.
Cutting down on alcohol. You can do this by swapping alcoholic drinks for non-alcoholic versions, sparkling water, or sugar-free soft drinks.
Reducing stress. Take steps to keep your stress levels under control. This can include practicing meditation, exercising regularly, spending time in nature, or speaking to a therapist.
You may need to take medication if your blood pressure levels are high. You may need to take this medication for the rest of your life, and it may take a while to find the right dose for you.
Medications to lower blood pressure include:
Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors are drugs that can relax and open up your blood vessels.
Angiotensin-2 receptor blockers (ARBs). These drugs also help your blood vessels relax and open up.
Diuretics. These medications help reduce how much water and salt is in your body.
Calcium channel blockers. As the name suggests, these medications block calcium from entering your heart’s cells and arteries. This can relax and open up your blood vessels.
Alpha-blockers. Alpha-blockers can relax the muscles in your artery walls.
Beta-blockers. Beta-blockers can lower your heart rate and help your heart not work so hard. You might be prescribed a combined alpha- and beta-blocker.
Alpha-2 receptor agonists. These can block signals from your brain that narrow blood vessels and increase your heart rate.
Vasodilators. These help to open up your blood vessels so blood can flow more easily.
This sounds like a lot, but your healthcare provider can recommend the best antihypertensive medication for you, depending on your situation. They can also walk you through the potential side effects and what you can expect.
If you decide to lose weight to help with hypertension control, weight loss medications may be useful.
Drugs like Ozempic® (semaglutide) and Mounjaro® (tirzepatide) can help people lose weight, and some — like Wegovy® and Zepbound® — are FDA-approved for those with overweight or obesity and high blood pressure.
Your healthcare provider can walk you through the pros and cons of weight loss medications and which ones could help you.
Interested in weight loss medications? Take our free assessment and connect with a licensed provider online.
You can’t always prevent high blood pressure, but there are some steps you can take to lower your odds of developing it.
Most of these steps involve healthy lifestyle changes.
You can reduce your chances of developing high blood pressure by:
Eating heart-healthy foods or following the DASH diet
Making physical movement part of your daily routine
Getting plenty of sleep
Maintaining a healthy weight
Limiting or avoiding alcohol
Managing stress
Quitting smoking
Keeping your cholesterol and blood sugar levels within healthy ranges