www.patientedu.org

written byHarvard Medical School

www.patientedu.org

written byHarvard Medical School

High Blood Pressure

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What Is It?Blood pressure is the force that propels your blood through your arteries. Since blood pressure can swing up and down, any one reading is just a snapshot of your usual pressure. When it comes to predicting complications, your average pressure is more important than your peaks and valleys.

Measuring Blood PressureYour doctor will measure two pressures each time you’re tested. The higher number is your systolic blood pressure, the pressure in your arteries each time your heart squeezes to pump blood. But after each beat, your heart relaxes and fills with blood to prime the pump for the next beat. Your diastolic blood pressure is the pressure in your arteries when your heart relaxes.

If your systolic blood pressure is 120 and your diastolic is 80, your doctor will tell you your reading is “120 over 80” and will write it as 120/80. To get an accurate reading, avoid caffeine, nicotine, and exercise before your pressure is checked. Stress can also boost blood pressure, so try to be relaxed.

Your doctor should always repeat your reading if it’s high. If your pressure is still high, your doctor may arrange to have a nurse or technician measure it

at home or work. You can also learn to check yourself with an automated digital arm cuff.

It’s a good way to tell stress from true hypertension, and it can also help

track treatment.

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What’s Your Pressure?You should have your blood pressure taken with every annual check-up. If it’s borderline or high, you may need it checked more often. When you are taking medications to control your high blood pressure, you also should closely monitor your pressure. It’s also good to ask for a blood pressure check whenever you go to a doctor, even if the problem is a sore throat or rash.

Measuring Blood Pressure

Step 1: A cuff is wrapped around your arm.

Step 2: The cuff is inflated, temporarily blocking blood flow in your artery.

Step 3: Air is released from the cuff, while a stetho-scope is used to listen to your artery.

a) When blood begins to flow again, your pulse becomes audible—the number on the dial is your systolic blood pressure.

b) As more air is released, the sounds become muffled and faint—that’s your diastolic blood pressure.

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What’s Normal?Table 1 shows the standards for blood pressure. Having either prehypertension or either stage of hypertension increases your risk of heart attacks and strokes. The higher your pressure, the more your risk goes up. If your systolic and diastolic pressures place you in different categories, use the number that puts you in the higher classification. For example, if your reading is 114/84, you have prehypertension. If your two arms give different readings, use the higher one.

The Burden of HypertensionAbout 73 million Americans have hypertension. Another 69 million have prehypertension. That means that at least 2 of every 3 American adults have unhealthy blood pressures. High blood pressure shaves 5 years off an average person’s life.

The American Heart Association calls hypertension “the silent killer” because it often doesn’t cause any symptoms until it damages your circulation. But even though you may feel okay, high blood pressure silently makes your heart work too hard, and it harms your arteries and blood vessels, making them stiffer and narrower. It can also damage your brain, eyes, and kidneys.

Systolic BP

Below 120

120–139

140–159

160+

and

or

or

or

Diastolic BP

Below 80

80–89

90–99

100+

Table 1| Classification of Blood Pressure for People 18 Years and Older

Classification

Normal

Prehypertension

Stage 1 hypertension

Stage 2 hypertension

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Lowering Blood Pressure: Goals and ResultsLowering your blood pressure even a little protects you a lot. Lowering your systolic pressure by 10 points or your diastolic pressure by 5 points reduces your risk of stroke by 30% to 40% and your risk of heart attack by 15% to 25%. Other conditions add to the risks of high blood pressure and call for special treatment goals (Table 2).

Lifestyle TherapyMaking lifestyle changes like the following can really add up when it comes to lowering blood pressure (See Table 3 on pages 8 and 9).

Eat a Healthy Diet. The DASH program is best. It calls for cutting down on animal fat, processed foods, and sweets. It emphasizes fruits, vegetables, and low- or nonfat dairy products—and includes whole grains, fish, poultry, and nuts. This eating plan is rich in potassium, magnesium, and calcium. These are nutrients that people with high blood pressure need.

Goal

140/90 or lower

130/80 or lower

Table 2| Goals of Therapy

Patient

Average patient

Diabetes, chronic kidney disease, heart disease

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Consume Less Salt. The DASH diet cuts the amount of sodium in your diet to 2,300 mg a day or less. But people with high blood pressure should aim for 1,500 mg a day or less. To reach that target, avoid canned and processed foods, as well as convenience foods like frozen dinners. Use herbs and spices instead of salt when cooking. Buy foods labeled as “low-sodium” or “reduced-sodium.”

Get Enough Vitamin D. Too little vitamin D seems to increase a person’s chances of a heart attack, stroke, or heart failure. The risk is doubled for people with high blood pressure. Because it isn’t naturally present in many foods, many doctors suggest taking a daily supplement that contains 1,000 IU of vitamin D.

Exercise. Regular exercise is important for your blood pressure and your overall health. You don’t have to spend long hours in a gym. As little as 30 minutes of moderate exercise, such as brisk walking, will help, as long as you do it nearly every day. Regular exercise greatly protects your health, even if it doesn’t cause you to lose weight.

Limit Alcohol Use. Small amounts of alcohol won’t raise your blood

pressure. Heavier drinking will. If you choose to drink, limit yourself to 2 drinks per day if you’re male or 1 drink per day if you’re female. Limiting the amount you

drink will also help you eliminate “empty” calories.

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Don’t Smoke. Nicotine raises your blood pressure and ups your risk for many other health problems. It can be hard to quit. To improve your chances of success, ask your doctor about nicotine replace- ment products and smoking cessation programs.

Control Your Weight. It’s one of the best ways to reduce blood pressure, but it’s also one of the hardest. Stick to a low-calorie diet and regular exercise. Writing down what you eat every day and how much you exercise can also help.

Reduce Stress. Mental tension and hypertension are not the same, and plenty of laid-back folks have high blood pressure. But if you’re under stress, it could be raising your blood pressure. For stress relief, get enough sleep, exercise regularly, and adopt relaxation techniques such as meditation, deep breathing exercises, and yoga.

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Home MonitoringIt is important to have your blood pressure checked regularly. It is inconvenient and unnecessary to go to the doctor frequently since today there are machines that can automatically take your blood pressure at home. The best machines put the blood pressure cuff on your upper arm, like the doctor does. The auto-matic machines are the easiest: you just slip the cuff on your arm, push a button, and the machine does the rest. If your doctor asks you to take your home blood pressures, please do it because it’s important to your health.

Potential Drop in Systolic Blood Pressure

8–14 points

2–11 points

4–9 points

2–4 points

5–20 points for every 22 pounds lost

2–8 points

Table 3 | How Lifestyle Changes Help

Lifestyle Change

Adopt the DASH Diet

Reduce Sodium

Exercise

Limit Alcohol

Lose Weight

Quit Smoking

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Adopt the healthful lifestyle that will keep your blood pressure

as low as possible.

MedicationToday’s medicines really work. In each individual, some medicines work better than others, and doctors may have to try several types to find the one that works for you. If you have hypertension and other diseases—such as diabetes, heart disease, or kidney disease—the doctor may prefer one type of blood pressure medicine over another. Therapy must always fit the individual. The goal is to control blood pressure with as few side effects as possible.

What To Do

Eat plenty of fruits and vegetables, choose low-fat dairy products, and reduce total fat consumption.

Try to consume no more than 1,500 mg of sodium a day.

Get at least 30 minutes of moderate aerobic exercise on all or most days of the week.

Have no more than 2 drinks per day if you’re male, or 1 drink per day if you’re female.

Reach and maintain a healthy body weight.

If you smoke, get the help you need to quit.

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There are several different classes of drugs for high blood pressure:

• Diuretics, particularly thiazide diuretics.

• Angiotensin-converting enzyme inhibitors, or ACE inhibitors.

• Angiotensin receptor blockers, or ARBs.

• Calcium-channel blockers.

• Beta blockers.

• Alpha-1 blockers.

• Vasodilators.

• Direct renin inhibitors.

• Other adrenaline-fighting drugs.

Since most blood pressure medications take time to work, doctors will generally adjust therapy about once a month. Once you’ve reached your goal, visits can be less frequent.

Ask your doctor about the side effects to look for, and remember to tell the doctor if you think you may be having them. Other blood pressure medicines may work just as well without causing side effects. Above all, don’t just stop taking your medicines.

Because people with high blood pressure often feel fine, they may forget to take their medication. These tips can help you remember to take yours:

• Use a weekly pillbox so you’ll know at a glance whether you’ve taken each day’s dose.

• Post self-stick reminder notes where you’ll see them.

• Keep your medicine with your toothpaste, and then take it after you brush your teeth.

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Notes:

About This Brochure: This brochure was written by practicing physicians from Harvard Medical School. It is part of a series developed and distributed by the Patient Education Center.

All the information in this brochure and on the associated Web site (www.patientedu.org) is intended for educational use only; it is not intended to provide, or be a substitute for, professional medical advice, diagnosis, or treatment. Only a physician or other qualified health care professional can provide medical advice, diagnosis, or treatment. Always consult your physician on all matters of your personal health.

Harvard Medical School, the Patient Education Center, and its affiliates do not endorse any products.

Consulting Physician: Anthony L. Komaroff, MD Editorial Director: Keith D’Oria

Creative Director: Jon Nichol

© Copyright Harvard Medical School.

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Learn more about high blood pressure, visit the Patient Education Center at www.patientedu.org/ hypertension.