High Blood Pressure


High Blood Pressure

About High Blood Pressure

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High blood pressure is one of the leading causes of heart attacks and strokes, yet one in five of the about 80 million Americans with high blood pressure don't know they have it. That's partly because the condition usually doesn’t cause any obvious symptoms, and because some people don’t get medical checkups as often as they should. Doctors, too, don't always check blood pressure. Be sure to get yours checked at every doctor appointment.

If you have high blood pressure, stick with your treatment. Studies show that about half of people treated for high blood pressure don't get it under control. That's unfortunate—and unnecessary. In some cases, a committment to making lifestyle changes—such as eating a healthful diet, losing weight, reducing salt intake, and getting regular exercise—can lower blood pressure enough so that medication may not be needed. When they don't, low-cost medicines can help.

Common Symptoms

Usually you do not have any symptoms. The only way to know if you have high blood pressure is to get it checked using a blood pressure cuff.

Get Screened

Your heart is a powerful muscle that pumps blood through your arteries. To withstand that pressure, healthy arteries need to be flexible. Anything that makes them less so—getting older, certain medications, and risk factors such as inactivity, obesity, and smoking, or having a genetic predisposition, for example—can make blood pressure rise. Over time, that excessive pressure can damage blood vessels throughout the body, and increase a person’s risk for heart attacks, strokes, and heart failure as well as kidney damage, vision loss, arterial blockages in the legs, and sexual impotency.

That’s why it’s important to detect high blood pressure early, so you can get proper treatment before the damage occurs. You should have your blood pressure checked at least once every two years, and more often if you're 50 or older or have other risk factors for hypertension. For most people, it's a good idea to have it done during every visit to a health-care provider.

If your initial reading is elevated, don't panic. A number of factors—including pain and emotional stress and even feeling nervous in the doctor’s office—can temporarily boost blood pressure. To improve the accuracy:

  • Don't smoke, exercise, or consume anything caffeinated for at least an hour before your appointment.
  • Go to the bathroom first, since a full bladder can affect the reading.
  • Sit with your feet flat on the floor for 5 minutes before the reading. Rest your arm on a table so it's at heart level. Remain quiet during the test.

If your blood pressure is high, your doctor may take another reading after about 5 minutes or so. If the reading is still elevated and you have no history of previous high readings, you should get another reading in a couple of weeks before initiating treatment. You can either come back to your doctor’s office, or take your blood pressure at home following your doctor’s recommendations. Good blood pressure equipment can be purchased at most drugs stores.

In fact, in such circumstances, your doctor may ask you to measure your blood pressure several times or even every day over a period of a week or so. He or she will calculate the average of all the measurements to get a final reading.

The reason to be sure your blood pressure is indeed elevated before starting on a medication is that the medicines used to treat it can have side effects. Plus, people with normal blood pressure should not take medicines because having excessively low blood pressure can be dangerous, increasing the risk for experiencing dizziness and putting some people at risk for accidents and falls.

What do the numbers mean?

Blood pressure is the force exerted by blood against the walls of your arteries as it flows through your body. It is measured as two numbers, one over the other—for example, 120 over 80. The measurement is in millimeters of mercury, expressed as “mmHg.” The systolic (upper) number is the pressure in the arteries when the heart contracts. The diastolic (lower) number is the pressure when the heart rests between contractions. An elevation in either or both of those numbers signals high blood pressure. See chart below for more details.

Importantly, even if your blood pressure is not elevated enough to be considered high, the risk of a heart attack or stroke increases as pressure rises above normal.

What Causes it?

Hypertension is the medical term used to describe having high blood pressure.  The term can be easily misinterpreted—some may believe high blood pressure is related to “tension” or stress, but that is not usually true. High blood pressure is often linked to weight gain, poor diet, and sedentary lifestyle. Family history, getting older and gaining weight also play a role. A high salt diet may contribute as well.

For the same reasons, and perhaps due to genetic factors as well, black Americans are more likely to have high blood pressure and to develop it at a younger age. And studies indicate they are more sensitive than Caucasian people to the blood pressure-raising effects of salt in their diet.

Am I at Risk?

In most cases, the cause of high blood pressure is unknown. Anyone can develop it, even if they are thin, healthy, and exercise regularly. But several factors are known to increase the risk, including:

  • Age. About 65 percent of people 60 and older have high blood pressure
  • Being overweight or obese
  • Drinking too much alcohol
  • Eating a high-salt diet
  • Family history of high blood pressure
  • Lack of exercise
  • Race. Black Americans are more likely than Caucasians and Hispanic Americans to develop high blood pressure
  • Smoking

Consumer Reports Recommendation

Recommended first-choice blood pressure drugs

  • Thiazide diuretics
  • Calcium channel blockers (CCBs)
  • Angiotensin-converting enzyme inhibitors (ACE inhibitors)
  • Angiotensin receptor blockers (ARBs)

Do not use these types of drugs as a first treatment

  • Adrenergeic neuronal depleting agents
  • Aldosterone receptor antagonists
  • Beta-blockers
  • Alpha blockers
  • Vasodilating beta blockers
  • Direct vasodilators
  • Central adrenergic antagonists
  • Loop diuretics

Are they Effective?

If a healthy diet and lifestyle changes alone don't lower your blood pressure enough, or if your levels are very high to begin with, you should consider medication. The drugs used to treat high blood pressure are effective and relatively safe, and most are available as low-cost generics. But they can cause side effects, as listed in the table below.

Many doctors will recommend initial treatment with a group of drugs called thiazide diuretics, sometimes known as "water pills." Studies have consistently shown these drugs (such as chlorthalidone, and hydrochlorothiazide) work for most people who take them, have been used for more than 50 years, are inexpensive, and have a very good safety record. In addition, they outperform all other types of high blood pressure drugs in reducing the risk of death from heart failure.

Still, many doctors routinely prescribe other blood pressure medicines, including newer, more expensive ones. In addition to thiazide diuretics, the guidelines this report is based on recommend three types of drugs for potential initial treatment, or if a second (or even third) drug is needed to lower your blood pressure. They are: calcium channel blockers (CCBs); angiotensin-converting enzyme inhibitors (ACEIs); and angiotensin receptor blockers (ARBs).

There are many individual drugs within each group, but studies do not show that any one drug is safer or more effective than another in each group. Among the recommended blood pressure drugs, the specific type of blood pressure medicine is usually less important than getting your pressure under control. Your race and age, health status, and other factors may influence which type of drug your doctor recommends.

The latest guidelines on which this report is based also recommend against taking several other types of high blood pressure drugs as first-choice treatment. So, if you are prescribed a drug from one of these groups as initial treatment, you should ask your doctor why.  If you are prescribed a second drug—because the first one didn’t lower your pressure enough—and it is in one of these groups, again, ask why.

Black Americans experience better results—lower blood pressure and prevention of heart attacks, heart failure, strokes, and death—when they are given a thiazide diuretic or a CCB as first-line treatment. And some studies point to the use of a thiazide diuretic first, with a CCB added to treatment if the diuretic doesn’t lower pressure to the desired goal.

People with high blood pressure and kidney disease represent another special case. Studies suggest they should take an ACEI or ARB—either as first line treatment or as a second drug—because it’s better for their kidney disease.

Because many black Americans with high blood pressure and kidney disease will need two (or more) medicines to reduce their pressure, a reasonable treatment choice is a thiazide diuretic plus an ACEI or ARB.

Another special case: If you have angina or coronary artery disease, have had a heart attack, or if you have certain heart-rhythm or heart muscle abnormalities, or heart failure, a beta blocker is the best choice if you are also given a high blood pressure diagnosis. Among them are metoprolol (Toprol-XL and generic), nadolol (Corgard and generic), and propranolol (Inderal and generic). They lower blood pressure and reduce the heart’s workload. If a beta-blocker doesn’t lower blood pressure enough, your doctor may add a second medicine that may also help counter your other problems.

Which drug is right for you?

Are they Safe?

Warning: Don’t ever take an ACEI and ARB at same time.  The combination can damage your kidneys.

No matter what drug or combination of drugs you take, several steps can minimize the chance of side effects and increase the likelihood that you'll stick with therapy:

  • Get your blood levels of potassium checked periodically, since diuretics can reduce your levels of that mineral.
  • Call your doctor if you have cramps, vomiting, or your heart rate or pulse increases, which can indicate low potassium levels.
  • Watch for signs of gout—for example, an inflamed big toe or knee.
  • If you also have diabetes, monitor your blood sugar level extra carefully because drugs for high blood pressure can cause it to fluctuate.
  • Follow the dosing instructions for your medication carefully and read the product label for possible side effects and other safety concerns you should be aware of.

Are there Over-the-Counter Options?

Don’t rely on supplements

While a diet rich in potassium and possibly calcium can help control blood pressure, it's unclear if supplements have the same effect. And some recent research suggests that too much calcium from supplements might increase the risk of heart disease and other health problems.

As for potassium, the form in supplements (and salt substitutes) might not have the same effect as the kind in foods. And too much of it, even from food, can cause problems for people with heart failure or kidney disease, and for those who take certain blood pressure drugs, including ACE inhibitors, angiotensin receptor blockers, and potassium-sparing diuretics such as spironolactone (Aldactone and generic). So talk with a doctor before increasing your intake.

If you take diuretics, your doctor may prescribe a potassium supplement, because those medicines can lower potassium levels.

Are there Non-Drug Options?

Even if you don't have high blood pressure, it's important to take steps to keep it under control because it tends to get higher with age.

That's especially important if you're a black American or have a family history of the condition, since both sharply increase the risk of developing it. And a healthy diet and lifestyle are essential if you already have high-normal (pre-hypertensive) readings. 

For people with high blood pressure, lifestyle measures can sometimes reduce or even eliminate the need for drugs. For example, research has found that the DASH diet (Dietary Approaches to Stop Hypertension) can be as effective as medication for some people with mild hypertension. This relatively low-sodium diet (1 teaspoon of sodium or less than 2,400 mg per day) relies on fruit, vegetables, and low-fat dairy products. The potassium in those foods, and possibly the calcium, too, appear to help control blood pressure.

For people with normal blood pressure and no heart disease or stroke risk factors, the suggested 2,400 mg daily sodium limit, achievable by adopting the DASH diet alone, might help ward off the upward creep of blood pressure that can occur with age. Other steps include losing excess weight, exercising regularly, and drinking alcohol only in moderation, as shown in the table below.

Control high blood pressure with diet, exercise, and weight loss

The steps below can help lower your blood pressure by as much as 45 points.

Adopt the DASH diet

DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet includes lots of fruits, vegetables, grains, low-fat dairy products, and foods that are low in saturated fat and total fat, such as fish and beans.

Eat less salt

Do not eat more than a teaspoon of sodium (2,400 mg) a day. This includes the salt in packaged foods. Read the Nutrition Facts label. Look for the words “Reduced Sodium” or “Low Sodium” on the package. Put away the saltshaker. Season foods with herbs and spices.

Limit alcohol

Men should have no more than two drinks a day. Women should have no more than one. A drink is a bottle of regular beer (12 ounces), a glass of wine (5 ounces), or one shot (1.5 ounces) of 80-proof liquor.

Be active

Try to get at least 30 minutes of brisk activity most days of the week, such as fast walking. Brisk activity, also called aerobic activity, gets your heart beating faster.

Lose extra weight

Try to keep your body mass index under 25. To learn more about your body mass index, go to: http://www.nhlbi.nih.gov/health/educational/lose_wt/bmitools.htm.


Consumer ReportsBest drugs to treat high blood pressure. The least expensive medications may be the best for many people. Published November 2014.