Condition Basics

What is high blood pressure?

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries. It's normal for blood pressure to go up and down throughout the day. But if it stays up, you have high blood pressure (hypertension).

Two numbers tell you your blood pressure. The first (top) number is the systolic pressure. It shows how hard the blood pushes when your heart is pumping. The second (bottom) number is the diastolic pressure. It shows how hard the blood pushes between heartbeats, when your heart is relaxed and filling with blood.

High blood pressure means that the top number stays high, or the bottom number stays high, or both. For diagnosis, the top number may be 130 to 140 or higher. The bottom number may be 80 to 90 or higher.^{footnote 1}

High blood pressure increases the risk of stroke, heart attack, and other problems.

What causes it?

Experts don't fully understand the exact cause of high blood pressure. But they know that some things are linked to it. These include aging, drinking too much alcohol, eating a lot of sodium (salt), being overweight, and not exercising.

What are the symptoms?

High blood pressure doesn't usually cause symptoms. Most people don't know they have it until they go to the doctor for some other reason. Very high blood pressure (such as 180/110 or higher) can cause severe headaches and vision problems.

How is it diagnosed?

During a routine visit, your doctor will measure your blood pressure. Your doctor may ask you to test it again when you are home.^{footnote 2} This is because your blood pressure can change throughout the day. To diagnose high blood pressure, your doctor needs to know if your blood pressure is high throughout the day.

How is high blood pressure treated?

The two types of treatment for high blood pressure are lifestyle changes and medicines. Your doctor may ask you to lose extra weight, eat less sodium, and be more active. If these lifestyle changes don't help enough, you may also need to take daily medicines.

What can you do to prevent it?

A heart-healthy lifestyle can help you prevent high blood pressure. These changes are even more important if you have risk factors for high blood pressure that you can't change. These risk factors include race, age, and having others in your family who have high blood pressure.

Here are some things you can do.

• Stay at a healthy weight.
• Eat heart-healthy foods, and limit sodium.
• Get regular exercise.
• Limit alcohol.

What Increases Your Risk

Things that increase your risk (risk factors) for high blood pressure include:

• Having other people in your family who have high blood pressure.
• Aging.
• Eating a lot of sodium (salt).
• Drinking too much alcohol. Your risk of harm from alcohol is low if you have 2 drinks or less per week, moderate if you have 3 to 6 drinks per week, and high if you have 7 or more drinks per week.
• Being overweight or obese.
• Not getting exercise or physical activity.
• Race. People of African descent are more likely to get high blood pressure, often have more severe high blood pressure, and are more likely to get the condition at an earlier age than others. Why they are at greater risk isn't known.

Other possible risk factors include:

• Sleep apnea and sleep-disordered breathing.
• Certain medicines, such as birth control pills, amphetamines, some antidepressants, steroids, and some non-steroidal anti-inflammatory drugs (NSAIDs).

Prevention

Here are some things you can do to help prevent high blood pressure.

• Stay at a healthy weight.
• Try to limit how much sodium you eat to about 2,000 milligrams (mg) a day.
  • Buy foods that are labelled "unsalted," "sodium-free," or "low-sodium." Foods labelled "reduced-sodium" and "lightly salted" may still have too much sodium.
  • Flavour your food with garlic, lemon juice, onion, vinegar, herbs, and spices instead of salt. Do not use soy sauce, steak sauce, onion salt, garlic salt, mustard, or ketchup on your food.
  • Use less salt (or none) when recipes call for it. You can often use half the salt a recipe calls for without losing flavour.
• Be physically active. Get at least 2½ hours of exercise a week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
• If you drink alcohol, try to drink less. Your risk of harm from alcohol is low if you have 2 drinks or less per week, moderate if you have 3 to 6 drinks per week, and high if you have 7 or more drinks per week.
• Eat plenty of fruits, vegetables, and low-fat dairy products. Eat less saturated and total fats.

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What Happens

When blood pressure is high, it starts to damage blood vessels, called arteries, and your heart. Damaged arteries can lead to problems throughout your body. The higher your blood pressure, the greater your risk.

This damage doesn't happen all at once. It happens slowly over time. But you can't tell that it's happening, because you don't feel anything.

High blood pressure can lead to:

Heart failure.

High blood pressure makes your heart work harder. And that can lead to heart failure, which means your heart doesn't pump as much blood as your body needs.

Heart attack and stroke.

High blood pressure can cause atherosclerosis or "hardening of the arteries." This problem happens when the inner lining of an artery is damaged. Fat and calcium can build up in the artery wall. This buildup is called plaque. Over time, plaque can cause problems throughout the body. These problems include coronary artery disease, peripheral artery disease, heart attack, and stroke.

Vision loss and kidney disease.

Arteries also carry blood and oxygen to organs like your eyes and kidneys. If high blood pressure damages those arteries, it can lead to vision loss and kidney disease.

Problems in your brain.

High blood pressure can also affect the arteries in your brain, raising the risk of dementia and a stroke caused by bleeding in the brain.

High blood pressure usually can't be cured. But it can be controlled. Lowering blood pressure lowers the risk of damaging blood vessels. To lower it, you may make lifestyle changes, take medicines each day, or both.

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When to Call a Doctor

Call 911 anytime you think you may need emergency care. This may mean having symptoms that suggest that your blood pressure is causing a serious heart or blood vessel problem. Your blood pressure may be over 180/110.

For example, call 911 if:

• You have symptoms of a heart attack. These may include:
  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
  • Light-headedness or sudden weakness.
  • A fast or irregular heartbeat.
• You have symptoms of a stroke. These may include:
  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.
• You have severe back or belly pain.

Do not wait until your blood pressure comes down on its own. Get help right away.

Call your doctor now or seek immediate care if:

• Your blood pressure is much higher than normal (such as 180/110 or higher), but you don't have symptoms.
• You think high blood pressure is causing symptoms, such as:
  • Severe headache.
  • Blurry vision.

Watch closely for changes in your health, and be sure to contact your doctor if:

• Your blood pressure measures 140/90 or higher at least 2 times. That means the top number is 140 or higher or the bottom number is 90 or higher, or both.
• You think you may be having side effects from your blood pressure medicine.

Your blood pressure can be checked:

• Your blood pressure is usually normal, but it goes above normal at least 2 times.
• At drugstores, health fairs, fitness centres, community centres, fire stations, and ambulance stations.

Examinations and Tests

During a routine visit, your doctor will measure your blood pressure. Your doctor also may ask you to test it again when you are at home.^{footnote 1} This is because your blood pressure can change throughout the day. Sometimes it's high only because you are seeing a doctor. This is called white-coat hypertension.

To diagnose high blood pressure, your doctor needs to know if your blood pressure is high throughout the day. You may get an ambulatory blood pressure monitor. This is a small device that you wear all of the time for a day or two. It records your blood pressure at certain times. Or you may check your blood pressure several times a day with a home blood pressure monitor.

Your doctor also may do a physical exam and ask you questions about your health.

Regular blood pressure checks

Your care provider uses a blood pressure monitor to screen for high blood pressure. A blood pressure cuff is wrapped around your bare upper arm. The cuff is then pumped up. The cuff is slowly deflated, and the monitor shows your blood pressure numbers.

Hypertension Canada recommends regular blood pressure testing for adults.^{footnote 2}

Your doctor can let you know how often you should get your blood pressure checked. It may depend on what your blood pressure is and your risk for heart disease.

Children and teens

Children and teens typically have their blood pressure checked during routine checkups. Blood pressure checks typically start at age 3.^{footnote 2} After age 18, men and women can follow the adult screening guidelines.

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Treatment Overview

The treatments for high blood pressure are lifestyle changes and daily medicines.

Treatment depends on how high your blood pressure is and if you have other health problems, like diabetes. It also depends on whether any organs have already been damaged. Your doctor also may check your risk for other problems, like heart attack and stroke.

Your doctor will give you a blood pressure goal based on your health and your age.

Your doctor will suggest making lifestyle changes. It may help to:

• Stay at a healthy weight. Or it may help to lose weight, if you need to.
• Be physically active.
• Limit alcohol.
• Eat less sodium.
• Eat heart-healthy foods.

If these changes aren't enough to bring your blood pressure down to your goal, your doctor may recommend that you take pills.

Most people who take pills for high blood pressure need to take two or more kinds of pills that work together.

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Self-Care

The best thing you can do for yourself is to try to lower your blood pressure. You can do this by making changes to your diet, getting more exercise, and losing weight if you need to. A heart-healthy lifestyle is always important, even if you take blood pressure medicines too.

For some people, lifestyle changes alone may be enough to lower their blood pressure.

Here are the key steps to lowering your blood pressure.

• Stay at a healthy weight.

  If you are overweight, losing as little as 4.5 kg (10 lb) may lower your blood pressure. It may also allow you to take less blood pressure medicine.

• Eat heart-healthy foods.

  Getting enough of the nutrients found in fruits, vegetables, and dairy products helps lower blood pressure. Use the DASH eating plan as a guide.

• Cut back on sodium.

  Try to limit how much sodium you eat to about 2,000 milligrams (mg) a day.

• Get active.

  Regular physical activity can lower blood pressure in those who have high blood pressure. Try to do moderate to vigorous activity at least 2½ hours a week.

• Check your blood pressure.

  A home blood pressure monitor makes it easy to keep track of your blood pressure. Seeing those small improvements can motivate you to keep going with your lifestyle changes.

• If you smoke, try to quit.

  Smoking increases your risk for heart attack and stroke.

• Limit alcohol.

  If you drink, try to drink less. Your risk of harm from alcohol is low if you have 2 drinks or less per week. Work with your doctor to find what is right for you.

• If you think you may have a problem with alcohol or drug use, talk to your doctor.

  This includes prescription medicines (such as amphetamines and opioids) and drugs (such as cocaine and methamphetamine). Your doctor can help you figure out what type of treatment is best for you.

• If you take blood pressure medicine, take it exactly as prescribed.

  Sometimes people find it hard to take their medicine as prescribed. They may feel it's too much trouble—especially when they don't feel sick. Or they may be worried about side effects. Some people find it hard to keep track of when and how to take their medicine. Work with your doctor to find the right medicine or combination of medicines that have the fewest side effects and work well for you.

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Medicines

Doctors usually first prescribe a single, low-dose medicine for high blood pressure. If this doesn't work, your doctor may change the dosage or try a different medicine or combination of medicines. It's common to try several medicines before blood pressure is controlled. Many people need more than one medicine to get the best results.

You may have regular blood tests to monitor how the medicine is working in your body. Your doctor will likely let you know when you need to have the tests.

You may need to avoid some medicines that you can buy without a prescription. For example, check with your doctor before you take any non-steroidal anti-inflammatory drugs (NSAIDs) if you are taking medicines for high blood pressure. NSAIDs include naproxen and ibuprofen. NSAIDs may raise blood pressure and keep your blood pressure medicines from working well. They may also interact with your blood pressure medicine and cause kidney problems.

Medicine choices

The first medicines used may be:

• ACE inhibitors.
• Thiazide diuretics.
• Calcium channel blockers.
• Angiotensin II receptor blockers (ARBs).

Other medicines used include:

• Beta-blockers.
• Alpha-blockers.
• Vasodilators.

All of these medicines work well to lower the risk of heart attack and stroke.

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Complementary Treatment

Complementary treatments haven't been proven to lower high blood pressure. But these treatments may be used to help manage stress and improve quality of life.

Tell your doctor if you use, or plan to use, complementary treatments to help manage your blood pressure. These treatments don't replace lifestyle changes or medicine for high blood pressure. You use this type of treatment in addition to your doctor's standard care. You and your doctor can decide which treatment might be best for you.

Complementary treatments include:

• Acupuncture.
• Biofeedback.
• Meditation.
• Stress management and relaxation.
• Yoga.

Most mind and body practices—such as acupuncture and yoga—are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.

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