Blood Pressure

What is blood pressure?

Blood pressure (BP) is the force of blood pushing on the walls of your arteries. Your BP results are written as 2 numbers. The first, or top, number is called systolic BP. This is the pressure caused by your heart pushing blood out to your body. The second, or bottom, number is called diastolic BP. This is the pressure when your heart relaxes and fills back up with blood. Ask your healthcare provider what your BP should be. For most people, a good BP goal is less than 120/80.

Why do I need to take my BP?

You may not have any signs or symptoms of high BP. You may need to take your BP regularly to know how often your BP is high. High BP increases your risk for a stroke, heart attack, or kidney disease. You may need to take medicine to keep your BP at a normal level. Write down and keep a log of your BP. Your healthcare provider can use the BP results in your log to see if your BP medicines are working.

How often should I take my BP?

Your healthcare provider may recommend that you take your BP 2 times a day. Take your BP at the same times each day, such as the morning and evening. Ask your healthcare provider when and how often you should take your BP.

How do I take my BP?

You can take your BP at home with a digital BP monitor. Read the instructions that came with your BP monitor. The monitor comes with an adjustable cuff. Ask your healthcare provider if your cuff is the correct size.

Do not eat, drink, smoke, or exercise for 30 minutes before you take your BP.
Rest quietly for 5 minutes before you take your BP.
Sit with your feet flat on the floor and your back against a chair.
Extend your arm and support it on a flat surface. Your arm should be at the same level as your heart.
Make sure all of the air is out of the cuff. Place the BP cuff against your bare skin about 1 inch (2.5 cm) above your elbow. Wrap the cuff snugly around your arm. The BP reading may not be correct if the cuff is too loose.
If you are using a wrist cuff, wrap the cuff snugly around your wrist. Hold your wrist at the same level as your heart.
Turn on the BP monitor and follow the directions.
Write down your BP, the date, the time, and which arm you used to take the BP. Take
your BP 2 times and write down both readings. Use the same arm each time. These BP
readings can be 1 minute apart.

What else do I need to know?

Do not take a BP reading in an arm that is injured or has an IV or shunt.
Take your BP medicines as directed. Do not stop taking your medicines if your BP is at your goal. A BP at your goal means your medicine is working correctly.
Bring the BP machine to your follow-up visit. Your healthcare provider can check that you are using it correctly.

Prehypertension (Elevated Blood Pressure)

What is prehypertension?

Prehypertension is a blood pressure level that is elevated, or slightly higher than normal. Blood pressure is the force of your blood pressing against the walls of your arteries. Normal blood pressure is 119/79 or lower. Prehypertension is 120/80 to 129/80.
Prehypertension increases your risk for chronic (long-term) high blood pressure. Prehypertension and high blood pressure increase your risk for heart and blood vessel disease. Over time, this
increases your risk for a life-threatening heart attack, stroke, heart failure, or kidney disease.

What increases my risk for prehypertension?

Obesity or lack of exercise
Eating too much sodium (salt)
Low intake of fruits, vegetables, and other foods high in potassium
Use of tobacco, alcohol, or illegal drugs
A medical condition, such as diabetes, high cholesterol, or sleep apnea
Medicines, such as steroids or birth control pills
A family history of hypertension or heart disease
Age older than 55 years (men)
Age older than 65 years (women)

How is prehypertension diagnosed?

Your healthcare provider will ask if you have a family
history of high blood pressure. He or she will also ask about the medicines you take and any
health conditions you have. He or she will check your blood pressure using a blood pressure cuff. Your healthcare provider may take more than one blood pressure reading, and take the average of these readings.

How can I manage prehypertension?

The goal is to lower your blood pressure into the normal range. Talk to your healthcare provider about these and other lifestyle changes you may need to make. Lifestyle changes can help prevent the need for medicine to lower your blood pressure.

Hypertension

What is hypertension?

Hypertension is high blood pressure. Your blood pressure is the force of your blood moving against the walls of your arteries. Hypertension causes your blood pressure to get so high that your heart has to work much harder than normal. This can damage your heart. The cause of hypertension may not be known. This is called essential or primary hypertension. Hypertension caused by another medical condition, such as kidney disease, is called secondary hypertension.

Normal blood pressure is 119/79 or lower. Your healthcare provider may only check
your blood pressure each year if it stays at a normal level.
Elevated blood pressure is 120/79 to 129/79. This is sometimes called prehypertension. Your healthcare provider may suggest lifestyle changes to help lower your blood pressure to a normal level. He or she may then check it again in 3 to 6 months.
Stage 1 hypertension is 130/80 to 139/89. Your provider may recommend lifestyle changes, medication, and checks every 3 to 6 months until your blood pressure is controlled.
Stage 2 hypertension is 140/90 or higher. Your provider will recommend lifestyle changes and have you take 2 kinds of hypertension medicines. You will also need to have your blood pressure checked monthly until it is controlled.

What increases my risk for hypertension?

Age older than 55 years (men) or 65 (women)
Stress, or a family history of hypertension or heart disease
Obesity, lack of exercise, or too many high-sodium foods
Use of tobacco, alcohol, or illegal drugs
A medical condition, such as diabetes, kidney disease, thyroid disease, or adrenal gland disorder
Certain medicines, such as steroids or birth control pills

What are the signs and symptoms of hypertension?

You may have no signs or symptoms, or you may have any of the following:

Headache
Blurred vision
Chest pain
Dizziness or weakness
Trouble breathing
Nosebleeds

How is hypertension diagnosed?

Your healthcare provider will take your blood pressure at several visits. You may also need to check your blood pressure at home. The provider will examine you and ask what medicines you take. He or she will also ask if you have a family history of high blood pressure and about any health conditions you have. He or she will also check your blood pressure and weight and examine your heart, lungs, and eyes. You may need any of the following tests:

An ambulatory blood pressure monitor (ABPM) is a device that you wear. ABPM measures your blood pressure while you do your regular daily activities. It records your blood pressure every 15 to 30 minutes during the day. It also records your blood pressure every 15 minutes to 1 hour at night. The recorded blood pressures help your healthcare provider know if you have hypertension not seen at your appointment.
Blood tests may help healthcare providers find the cause of your hypertension. Blood tests can also help find other health problems caused by hypertension.
Urine tests will be done to check your kidney function. Kidney problems can increase your risk for hypertension.

Which medicines are used to treat hypertension?

Antihypertensives may be used to help lower your blood pressure. Several kinds of
medicines are available. Your healthcare provider will choose medicines based on the kind of hypertension you have. You may need more than one type of medicine. Take the medicine exactly as directed.
Diuretics help decrease extra fluid that collects in your body. This will help lower your blood pressure. You may urinate more often while you take this medicine.
Cholesterol medicine helps lower your cholesterol level. A low cholesterol level helps prevent heart disease and makes it easier to control your blood pressure.

Hypertensive Crisis

What is a hypertensive crisis?

A hypertensive crisis is a sudden spike in blood pressure to 180/120 or higher. A normal blood pressure is 119/79 or lower. A hypertensive crisis is also known as acute hypertension. This is a medical emergency that could lead to organ damage or be life-threatening.

What increases my risk for a hypertensive crisis?

Not taking your blood pressure medicine as directed
Hypertension caused by pregnancy (preeclampsia, eclampsia)
Thyroid disease, kidney or adrenal disease, heart disease, or stroke
Cocaine or amphetamine use
Cigarette smoking or alcohol abuse
Burns, head injuries, surgery, or trauma

What are the signs and symptoms of a hypertensive crisis?

Blurred vision or headache
Nausea or vomiting
Shortness of breath or chest pain
Dizziness or weakness
Problems with thinking or behavior changes, such as sleepiness, forgetfulness, or confusion

How is a hypertensive crisis diagnosed?

Your healthcare provider will ask if you have health conditions, such as high blood pressure, diabetes, or heart disease. He or she will ask what your symptoms are and if you have ever had surgery. Tell him or her what medicines you take and if you have ever used illegal drugs. Your healthcare provider will check your blood pressure on both arms and listen to your heart and lungs. He or she will examine your eyes closely and also test your strength, balance, reflexes, and memory. The following tests may be done to check for damage to your heart, brain, and kidneys:

Blood or urine tests are done to find out if your liver and kidneys are functioning properly. High blood pressure can damage your kidneys.
An EKG is used to monitor your heart. Sticky pads placed on your skin record your heart's electrical activity.
X-ray or CT pictures may show signs of a stroke, heart failure, or fluid around your heart and lungs. You may be given contrast liquid before a CT scan to help healthcare providers see the pictures better. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid.

How is a hypertensive crisis treated?

Treatment depends on the cause of your hypertensive crisis. Healthcare providers will lower your blood pressure and try to prevent organ damage. You may need the following:

Blood pressure medicine is given to lower your blood pressure. There are many different types of blood pressure medicine, and you may need more than one type. It is very important to take your blood pressure medicine exactly as directed. Skipped doses can lead to a hypertensive crisis. Talk to your healthcare provider if you are having side effects from your medicine. Do not stop taking it without talking to your healthcare provider.
Diuretics help decrease extra fluid that collects in your blood vessels. This lowers your blood pressure by reducing pressure in your arteries. Diuretics are often called water pills. You may urinate more often while you take this medicine.

What are the risks of a hypertensive crisis?

Even with treatment, you are at risk for a heart attack, stroke, or kidney damage. You could develop a bulge or tear in the wall of your aorta (the artery that supplies blood throughout your body). Fluid could collect in your lungs and make it hard for you to breathe. You are at risk for blindness, eye damage, seizures, as well as brain damage.

Ways to Lower Your Blood Pressure

Check your blood pressure as directed.

Your healthcare provider will tell you how often to check your blood pressure. Regular checks can help you monitor your blood pressure levels and make lifestyle changes if needed. Your provider may want you to keep a record of your blood pressure readings. Bring the record with you to follow-up appointments.

Eat less sodium (salt).

Do not add sodium to your food. Limit foods that are high in sodium, such as canned foods, potato chips, and cold cuts.

Follow the meal plan recommended by your healthcare provider.

Your healthcare provider may suggest that you follow the DASH Eating Plan. This eating plan is low in sodium, unhealthy fats, and total fat. It is high in potassium, calcium, and fiber.

Exercise to maintain or reach a healthy weight.

Exercise at least 30 minutes per day, on most days of the week. This will help decrease your blood pressure. Ask your healthcare provider about the best exercise plan for you.

Decrease stress.

This may help lower your blood pressure. Learn ways to relax, such as deep breathing or listening to music.

Limit alcohol.

Ask your healthcare provider if it is safe for you to drink alcohol. Women should limit alcohol to I drink a day. Men should limit alcohol to 2 drinks a day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1 ½ ounces of liquor.

Do not smoke.

Nicotine and other chemicals in cigarettes and cigars can increase your blood pressure and cause lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.

Ask about all medicines.

Certain medicines can increase your blood pressure. Examples include oral birth control pills, decongestants, herbal supplements, and NSAIDs, such as ibuprofen. Your healthcare provider can tell you which medicines are safe for you to take. This includes prescription and over-the-counter medicines.

Manage any other health conditions you have.

Go to regular follow-up visits with your healthcare provider to manage these conditions. Blood pressure medicine may be needed if you cannot lower your blood pressure.