Blood pressure refers to the pressure that blood applies to the inner walls of the arteries. Arteries carry blood from the heart to other organs and parts of the body. “Hypertension” is the medical term for high blood pressure.

What is Blood Pressure?

An individual’s blood pressure is defined by two measurements:

●Systolic pressure is the pressure in the arteries produced when the heart contracts (at the time of a heart beat)

●Diastolic pressure refers the pressure in the arteries during relaxation of the heart between heart beats

Blood pressure is reported as the systolic pressure over diastolic pressure (eg, 120/70 or “120 over 70”).

Untreated high blood pressure increases the strain on the heart and arteries, eventually causing organ damage. High blood pressure increases the risk of heart failure, heart attack (myocardial infarction), stroke, and kidney failure.

High Blood Pressure Definition

The following definitions were proposed in 2017 by the American College of Cardiology/American Heart Association (ACC/AHA); other expert groups may differ slightly in how they define hypertension and when they recommend treatment.

Normal blood pressure — Less than 120 over less than 80.

Elevated blood pressure — 120 to 129 over less than 80.

People with elevated blood pressure are at increased risk of developing hypertension and cardiovascular complications; however, medications used to treat hypertension are not known to be beneficial in people with elevated blood pressure.

Hypertension

●Stage 1: 130 to 139 over 80 to 89

●Stage 2: At least 140 over at least 90

Most adults with hypertension have primary hypertension (formerly called “essential” hypertension), which means that the cause of the high blood pressure is not known. A small subset of adults has secondary hypertension, which means that there is an underlying and potentially correctable cause, usually a kidney or hormonal disorder.

High Blood Pressure Risk Factors

Although the exact cause of primary hypertension remains unclear, several risk factors have been identified. Your risk is higher if you:

●Are older (the risk increases with advancing age)

●Have obesity

●Have a family history of hypertension (ie, relatives who had or have high blood pressure)

●Are a Black person

●Consume a lot of sodium (salt) in your diet

●Drink a lot of alcohol

●Do not get a lot of physical activity

Diagnosis

Hypertension is often identified through routine screening. Experts recommend that people 40 years and older without a history of hypertension have their blood pressure checked once a year; screening should happen more frequently in people with risk factors such as obesity or family history, or who have had elevated blood pressure in the past. For younger people without risk factors, screening every few years may be a reasonable approach.

If your blood pressure is found to be elevated or high during in-office screening, you may be asked to confirm the results by checking your blood pressure yourself at home. This is because in many cases, a person’s blood pressure temporarily increases when it is taken by a doctor, nurse, or other medical professional in the office setting. This is sometimes called “white coat hypertension.” Your health care provider will use the readings from your in-office blood pressure check and your at-home results to determine whether or not you have true hypertension.

Treatments

Untreated hypertension can lead to a variety of complications, including heart disease and stroke. The risk of these complications increases as your blood pressure rises above 115/75, which is still in the normal range. Treating high blood pressure can reduce your risk of heart attack, stroke, and death.

Lifestyle changes — Treatment of hypertension usually begins with lifestyle changes. Making these lifestyle changes involves little or no risk. Recommended changes often include:

●Reduce the amount of salt in your diet

●Lose weight if you are overweight or have obesity

●Avoid drinking too much alcohol

●Stop smoking

●Exercise at least 30 minutes per day most days of the week

These changes are discussed in detail in a separate article. (See “Patient education: High blood pressure, diet, and weight (Beyond the Basics)”.)

Medicine — A medicine to lower blood pressure may be recommended if your blood pressure is consistently high, usually at or above 140/90. Treatment with medicine is recommended at a lower blood pressure for some older people and for those with atherosclerosis (fatty deposits lining the arteries, as in coronary heart disease, stroke, or peripheral artery disease), diabetes, or chronic kidney disease complicated by protein in the urine. (See “Patient education: Type 1 diabetes: Overview (Beyond the Basics)” and “Patient education: Type 2 diabetes: Overview (Beyond the Basics)” and “Patient education: Chronic kidney disease (Beyond the Basics)”.)

High blood pressure medicines are discussed in a separate article. (See “Patient education: High blood pressure treatment in adults (Beyond the Basics)”.)