Patient information: High blood pressure in adults (Beyond the Basics)

HIGH BLOOD PRESSURE OVERVIEW

Hypertension is the medical term for high blood pressure. 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.

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), and stroke.

HIGH BLOOD PRESSURE DEFINITION

Normal blood pressure — Less than 120 over less than 80

Prehypertension — 121 to 139 over 81 to 89

People with prehypertension are at increased risk of developing hypertension and cardiovascular complications.

Hypertension

       Stage 1: 140 to 159 over 90 to 99
       Stage 2: greater than 160 over greater than 100

Most adults with hypertension have essential or primary 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.

HIGH BLOOD PRESSURE RISK FACTORS

Hypertension is a common health problem. In the United States, approximately 32 percent of African-Americans and 23 percent of white people and Mexican-Americans have hypertension.

Hypertension is more common as people grow older. As an example, among people over age 60, hypertension occurs in 65 percent of African-American men, 80 percent of African-American women, 55 percent of white men, and 65 percent of white women.

Unfortunately, many people's blood pressure is not well controlled. According to a national survey, hypertension was in good control in only 25 percent of African-Americans and whites and 14 percent of Mexican-Americans.

HIGH BLOOD PRESSURE SYMPTOMS

High blood pressure does not usually cause any symptoms.

HIGH BLOOD PRESSURE DIAGNOSIS

Many people are anxious when seeing a doctor or nurse. As a result, you are not diagnosed with hypertension unless your blood pressure is persistently high at two office visits at least one week apart.

The only exceptions to this are if the blood pressure is very high or if you have damage from high blood pressure, such as heart, eye, or kidney injury. Before a decision is made to begin treatment, you may be asked to measure your blood pressure at home or work.

HIGH BLOOD PRESSURE TREATMENT

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 110/75, which is still in the healthy 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 obese
• 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 information: 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 at or above 140/90. Treatment with medicine is recommended at a lower blood pressure for some people with diabetes, atherosclerosis (fatty deposits lining the arteries, as in coronary heart disease, stroke, or peripheral artery disease), or chronic kidney disease. (See "Patient information: Diabetes mellitus type 1: Overview (Beyond the Basics)" and "Patient information: Diabetes mellitus type 2: Overview (Beyond the Basics)" and "Patient information: Chronic kidney disease (Beyond the Basics)".)

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

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient information: Preeclampsia (The Basics)
Patient information: High blood pressure in adults (The Basics)
Patient information: Controlling your blood pressure through lifestyle (The Basics)
Patient information: Polycystic kidney disease (The Basics)
Patient information: The ABCs of diabetes (The Basics)
Patient information: Exercise (The Basics)
Patient information: High blood pressure and pregnancy (The Basics)
Patient information: Renovascular hypertension (The Basics)
Patient information: High blood pressure emergencies (The Basics)
Patient information: Aortic dissection (The Basics)
Patient information: Coronary heart disease in women (The Basics)
Patient information: Medicines for chronic kidney disease (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient information: High blood pressure, diet, and weight (Beyond the Basics)
Patient information: Diabetes mellitus type 1: Overview (Beyond the Basics)
Patient information: Diabetes mellitus type 2: Overview (Beyond the Basics)
Patient information: Chronic kidney disease (Beyond the Basics)
Patient information: High blood pressure treatment in adults (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Ambulatory blood pressure monitoring and white coat hypertension in adults
Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults
Approach to the patient with hypertension and hypokalemia
Can therapy be discontinued in well-controlled hypertension?
Cardiovascular risks of hypertension
Choice of therapy in essential hypertension: Clinical trials
Choice of therapy in primary (essential) hypertension: Recommendations
Definition, risk factors, and evaluation of resistant hypertension
Diet in the treatment and prevention of hypertension
Hypertension: Who should be treated?
Malignant hypertension and hypertensive encephalopathy in adults
Initial evaluation of the hypertensive adult
Management of severe asymptomatic hypertension (hypertensive urgencies)
Overview of hypertension in adults
Patient adherence and the treatment of hypertension
Perioperative management of hypertension
Prehypertension
Renin-angiotensin system inhibition in the treatment of hypertension
Salt intake, salt restriction, and essential hypertension
Establishing the diagnosis of renovascular hypertension
Secondary prevention of cardiovascular disease
Spontaneous intracerebral hemorrhage: Pathogenesis, clinical features, and diagnosis
Spontaneous intracerebral hemorrhage: Prognosis and treatment
Blood pressure measurement in the diagnosis and management of hypertension in adults
The metabolic syndrome (insulin resistance syndrome or syndrome X)
The prevalence and control of hypertension
Treatment of hypertension in blacks
Antihypertensive therapy to prevent recurrent stroke or transient ischemic attack
Treatment of hypertension in patients with diabetes mellitus
Treatment of hypertension in patients with heart failure
Treatment of hypertension in the elderly patient, particularly isolated systolic hypertension
Treatment of resistant hypertension
What is goal blood pressure in the treatment of hypertension?
Who should be evaluated for renovascular or other causes of secondary hypertension?

The following organizations also provide reliable health information.

• National Library of Medicine

     (www.nlm.nih.gov/medlineplus/healthtopics.html)

• National Heart, Lung & Blood Institute (NHLBI)

     (www.nhlbi.nih.gov)

• American Heart Association

     (www.americanheart.org)

• The Hormone Foundation

      (www.hormone.org)

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