High Blood Pressure (hypertension): What Is It and How Do You Control It?

Sara Exler, National Center for Health Research : 2014

What is Blood Pressure?

Blood pressure is the force of blood against the arteries as the heart beats. Two numbers measure blood pressure: systolic (the pressure when the heart beats) and diastolic (the pressure when the heart rests between beats). Blood pressure is usually written as systolic over diastolic like this: 120/80 mmHg.

High blood pressure (also called hypertension) affects approximately one in three adults in the United States, and fewer than half of all those people have their blood pressure under control. [1] High blood pressure is the most commonly diagnosed health problem in this country; it can lead to heart attack, stroke, kidney failure, and death if not detected early and appropriately treated.[2]

What is normal blood pressure? For adults 59 and under, it’s less than 120/80 mmHg. Between 120/80 and 139/89 mmHg is considered pre-hypertension, meaning you are on your way to developing high blood pressure. Hypertension or high blood pressure is diagnosed when a person under 59 regularly has blood pressure measurements of 140/90 mmHg and higher.[3]

New guidelines issued in 2013 by a panel of 17 experts (the Joint National Committee) determined that since people over 60 regularly have higher blood pressure, the diagnosis of hypertension in that age group and the recommendation of getting treatment should be reserved for blood pressure that is above 150/90 mmHg.

Normal Pre Hypertension Hypertension Hypertension for those aged 60 and above based on new JNC8 [end James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013;():. doi:10.1001/jama.2013.284427.]
Under 120/80 mmHg 120/80 mmHg – 139/89 mmHg Over 140/90 mmHg Over 150/90 mmHg

What Causes High Blood Pressure?

High blood pressure can be caused by family history, behaviors, and age. Individuals with a family history of high blood pressure and those with diabetes are more likely to have high blood pressure. Race is also a factor; African Americans are more likely than whites to have high blood pressure. Aging increases the likelihood of high blood pressure. Lack of physical activity, an unhealthy diet, being overweight, alcohol use, stress, and smoking also contribute to your chances of having high blood pressure. [4]

What You Should Do to Keep Your Blood Pressure in the Healthy Range?

  • Get Enough Sleep
  • Reduce Stress
  • Eat more fruits, vegetables, and whole grains
  • Exercise
  • Drink less alcohol
  • Don’t Smoke

 You can reduce your blood pressure by changing some of your habits. Improvements include maintaining a healthy diet, quitting smoking, limiting alcohol intake, exercising regularly, and controlling levels of stress. [5] Stress reduction not only helps reduce high blood pressure, but also helps alleviate many other health issues. Even sunshine can help; one 2014 study found that for those with mild hypertension, 30 minutes per day in the sun reduced blood pressure a small but significant amount, and overall blood pressure rates improved in the summer compared to the winter.[6]

Exercise

 Regular exercise can significantly help lower your blood pressure. Different studies have shown that at least 30 minutes of moderate exercise 3 or 4 times a week can help lower blood pressure 4-9mmHg.[7] Getting exercise doesn’t have to mean spending all day at the gym; parking further away and walking to the store, taking the stairs instead of the elevators, taking a brisk walk around the neighborhood, and joining local fitness groups are all ways to start increasing your activity levels. Don’t try to do too much too suddenly; work slowly and gradually increase your exercise intensity. Finding a particular type of movement you enjoy will help you better stay on track with a regular exercise routine. Always talk with your doctor before starting a new exercise routine.

Salt

 Eating less salt to reduce your high blood pressure mainly works in combination with other lifestyle changes, such as a better diet and more exercise.[8] Less salt has been found especially effective in lowering high blood pressure in African Americans, people middle aged and older, and people who are overweight.[9]  The previously accepted recommended sodium intake was 1500mg per day (less than half a teaspoon of salt) for those with high blood pressure.[10] Processed foods are very high in salt, making up more than 75% of our salt intake.  Most salt in your diet may be from foods you do not think of as salty, such as bread, cold cuts and processed meats, pizza, soup, cheese, pasta dishes, chicken dishes, sauces like ketchup and soy sauce, and frozen food. [11]  The easiest way to reduce your salt consumption is to cook your own food from fresh ingredients, because even if you add salt it is likely to be much less than in processed foods. In fact, studies show that when people are served low sodium foods but are allowed to add salt from a salt shaker, most people only add back 20% of the sodium removed from their food.[12] To lower your salt intake without sacrificing taste, consider experimenting with different spices and seasonings like garlic, lemon juice, ginger, cilantro, pepper, rosemary, or sage.

Monitoring Blood Pressure at Home

If your doctor recommends you monitor your blood pressure at home, there are a few good tips you should follow. Buy a good quality digital home blood pressure monitor. Make sure the cuff is the right size; different size cuffs are available to buy and the wrong size cuff will give inaccurate results. Take your home blood pressure monitor to the doctor and have it checked to make sure it is accurate, and to make sure you are using it correctly. Do not take your blood pressure for 30 minutes after eating, exercising, smoking, or drinking caffeine. [13] Monitoring your blood pressure at home is a good way to track any changes made by either better habits, medicine, or both. A 2013 study found that people who monitored their blood pressure at home were significantly more likely to have their blood pressure under control after six months then those who did not. [14]

Medicines for Treating High Blood Pressure

In addition to changing the recommendations for the diagnosis of high blood pressures for people over 60, the Joint National Committee also simplified their recommendations for different types of medications. If you are diagnosed with high blood pressure that you can’t control with diet and exercise, you will likely be prescribed one or a combination of the medicines below. African Americans shouldn’t take ACE inhibitors or ARBS. [15]

Blood Pressure Medications Description [end National Heart Lung and Blood Institute. Types of Blood Pressure Medications. http://www.nhlbi.nih.gov/hbp/treat/bpd_type.htm#ace]
thiazide-type diuretic Diuretics are also known as “water pills” because they help flush excess water and sodium from the body.  Hydrochlorothiazide (HCTZ) is a popular example.
calcium channel blocker (CCB) A CCB helps prevent calcium from entering the muscle cells in the arteries. This causes blood vessels to relax and blood pressure lowers.
angiotensin-converting enzymeinhibitor (ACEI) Angiotensin converting enzyme (ACE) inhibitors prevent the formation of angiotensin II, which narrows blood vessels. The blood vessels relax and it lowers blood pressure.  Lisinopril is a popular ACE inhibitor.
angiotensin receptor blocker (ARB) ARBS block blood vessels from angiotensin II. As a result, the vessels become wider and blood pressure goes down.

The FDA added a common drug which is used to treat life-threatening hypertension to it’s 2017 FDA “Watch List”; nitropress is under review for putting patients at risk for carboxyhemoglobinemia.

Bottom Line

High blood pressure is a common problem for American adults. If you have high blood pressure (hypertension), it’s important to establish a treatment plan with your doctor that includes not only medicine, but also healthy lifestyle choices such as lowering salt intake, a healthier diet, quitting smoking, exercising, and stress control.  If those strategies don’t work, you may need medication as well, but remember that all blood pressure medications have side effects.

For more information about blood pressure medication, you can read this article.

All articles are reviewed and approved by Dr.Diana Zuckerman and other senior staff.

  1. CDC. Vital Signs: Prevalence, treatment, and control of hypertension —United States, 1999–2002 and 2005–2008. MMWR 2011;60:103–8
  2. Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013;():. doi:10.1001/jama.2013.284427.
  3. http://www.cdc.gov/bloodpressure/risk_factors.htm.
  4. Prevalence of hypertension and controlled hypertension—United States, 2005-2008. MMWR. 2011;60 Suppl:94-7.
  5. Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013;():. doi:10.1001/jama.2013.284427.
  6. Irradiation of Human Skin Vasodilates Arterial Vasculature and Lowers Blood Pressure Independently of Nitric Oxide Synthase. Journal of Investigative Dermatology (20 January 2014) | doi:10.1038/jid.2014.27
  7. Effect Of Changing Levels Of Physical Activity on Blood-pressure and Haedonymics in Essential Hypertension The Lancet – 30 August 1986 ( Vol. 328, Issue 8505, Pages 473-476 ) DOI: 10.1016/S0140-6736(86)90354-5.
  8. Is Salt Dietary Reduction Worth the Effort?, The American Journal of Medicine, Volume 125, Issue 5, May 2012, Pages 433-439, ISSN 0002-9343, http://dx.doi.org/10.1016/j.amjmed.2011.10.023.
  9. alt and Hypertension: Is Salt Dietary Reduction Worth the Effort?, The American Journal of Medicine, Volume 125, Issue 5, May 2012, Pages 433-439, ISSN 0002-9343, http://dx.doi.org/10.1016/j.amjmed.2011.10.023.
  10. Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events. JAMA. 2011;306(20):2229-2238. doi:10.1001/jama.2011.1729.
  11. Food Categories Contributing the Most to Sodium Consumption—United States, 2007–2008, February 10, 2012 / 61(05);92-98.
  12. Strategies to reduce sodium intake in the United States. Henney JE, Taylor CL, Boon CS, eds. Washington, DC: The National Academies Press; 2010
  13. Systemic hypertension: mechanisms and diagnosis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 45.
  14. Effect of Home Blood Pressure Telemonitoring and Pharmacist Management on Blood Pressure Control: A Cluster Randomized Clinical Trial. JAMA. 2013;310(1):46-56. doi:10.1001/jama.2013.6549
  15. Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013;():. doi:10.1001/jama.2013.284427.