What is high blood pressure and how do you manage it?

High blood pressure is a condition that describes how forcefully blood moves through your blood vessels. High blood pressure, also called hypertension, is dangerous because if left untreated, it damages your blood vessels and heart, and can lead to complications like heart attack, stroke and kidney disease. This is why some people call high blood pressure a “silent killer.”

“You may not have any symptoms of high blood pressure at first. But it can get to the point where it causes a heart attack or stroke – you never want it to get that far,” said Dr. Nimisha Swali, a family medicine physician at IU Health. “But having hypertension doesn’t necessarily mean you’ll have to take medications forever. Our goal with treating blood pressure is to get you to a point where you don’t even notice it.”

How high blood pressure is diagnosed

A blood pressure reading using a cuff on your arm can help measure the resistance in your body (the systolic, or top number) versus the amount of blood in your body (the diastolic, or bottom number.) These are measured in millimeters of mercury, or mm Hg.

An ideal blood pressure is about 120/80 (diastolic/systolic). When those numbers creep up to about 140/90 or higher, this is considered hypertensive. (Readings over 180/110 indicate a hypertensive emergency that should be treated immediately.) You can think of hypertension like water rushing through a pipe. The top number describes how much force is pushing against the walls of the pipe, and the lower number describes how much water is flowing through.

While a single elevated blood pressure reading may indicate a need to keep an eye on your blood pressure, it doesn’t necessarily mean you’re hypertensive. Doctors will want to take two blood pressure readings on two separate occasions to confirm that you aren’t just nervous to be at the doctor’s office.

“Sometimes people have what we call ‘white coat hypertension,’ where someone’s first reading in the doctor’s office isn’t accurate. Maybe you’re nervous, or you have a busy day or you’re running late, but some people get a high blood pressure reading in the office that doesn’t necessarily mean that it’s hypertension,” said Dr. Swali. “It’s totally normal to have high blood pressure at the doctor’s office. That’s why we’ll ask you to monitor at home.”

Your doctor will likely ask you use a home blood pressure monitor to confirm elevated numbers. When you take your blood pressure at home, remember these key steps:

• Automatic, cuff-style monitors for the upper arm are recommended over wrist or finger monitors.
• Sit down with your feet flat and your legs uncrossed.
• Before you begin, sit still for about five minutes with your arm resting on a table.
• Place the cuff on the top of your arm, above the elbow.

Your doctor will likely order lab tests to check your electrolytes, kidney levels, complete blood count, thyroid and cholesterol to see if any other parts of your body are affected by elevated blood pressure.

Hypertension causes and risk factors

There are two different kinds of high blood pressure: primary and secondary. Primary hypertension is caused by genetics or lifestyle habits. Secondary hypertension describes when your high blood pressure is caused by another condition or disease. For instance, you could be taking an oral contraceptive, steroid or weight loss medication that causes high blood pressure.

The majority of hypertension is primary and caused by a combination of things. People have both modifiable (changeable) and unmodifiable (unchangeable) risk factors for high blood pressure.

Unmodifiable risk factors describe those that we’re born with, or risk factors that are set in our DNA. These include:

• Family history: If you have relatives with hypertension, you’re more likely to have it, too.
• Age: The older you are, the less elastic your blood vessels become, so it’s natural to experience higher blood pressure as we age.
• Race: Research suggests that Black people have a substantially higher risk for hypertension compared with white people.
• Social determinants of health: Poverty and the lack of access to healthcare, healthy food and places to exercise are also linked to high blood pressure.

Fortunately, there are many modifiable risk factors you can influence to improve your blood pressure. By improving these risk factors, you can reduce your risk of heart disease and other problems. Common modifiable risk factors that raise blood pressure include:

• Obesity and lack of exercise
• A high-salt diet
• Lack of sleep, including obstructive sleep apnea
• Increased stress
• Excessive alcohol or tobacco use

Dr. Swali normally recommends patients with high blood pressure increase physical activity to about 150 minutes a week, plan good sleep and stress management, limit alcoholic drinks to one per day and pursue a low-salt diet. Excessive salt intake is about three grams a day, so it’s important to stay under two. If you have high blood pressure, maintaining a healthy lifestyle and eating healthy food can go a long way toward controlling your levels.

“Salt is going to be your main one to avoid for hypertension. We usually also worry about cholesterol and encourage patients to eat more complex carbs and home-cooked meals and switch from red meat to salmon,” Dr. Swali said. “The diet with the most evidence for reducing blood pressure is the DASH eating plan because it focuses on low salt.”

Hypertension medication: When lifestyle changes aren’t enough

Sometimes people can have hypertension that is resistant to lifestyle changes. For instance, someone who has secondary hypertension caused by diseases like renal artery stenosis, or someone with very high hypertension (e.g., 170/100), may need to begin medications to bring down their levels.

There is a wide variety of medications available to blood pressure. The most common are:

• Angiotensin-converting enzyme (ACE) inhibitors. The body makes a chemical called angiotensin, which causes blood vessels to narrow. ACE inhibitors relax blood vessels to relieve blood pressure.
• Angiotensin II receptor blockers (ARBs) block the effects of the angiotensin chemical.
• Diuretics like chlorthalidone, also known as a “water pill,” help the body remove excess water and sodium that can contribute to higher blood pressure.
• Calcium channel blockers relax and open narrowed blood vessels by preventing calcium from entering the heart’s muscles or blood vessels.

If your doctor recommends that you start a blood pressure medicine, they will talk to you about the benefits and risks of your options to determine which is best for you. Your doctor may ask you to check your blood pressure at home for a month and return to the office to retake the labs to make sure your body is handling the medications well. Once you’re on a steady dose of medication, your doctor may ask you to check in every three to six months or, eventually, each year.

“If you make those lifestyle changes to work hard at diet and exercise, focus on reducing salt, getting to the gym, cutting out alcohol and addressing things like sleep apnea, you might be able to get off the blood pressure medications,” Dr. Swali said. “Just because we’re starting medicine doesn’t mean we’ll be on them for the rest of our lives.”

Blood pressure medications can cause side effects. For example, diuretics are known to cause frequent urination. Calcium channel blockers can cause swelling in the legs, so it’s important to let your doctor know if you experience any side effects so they can adjust your medicine.

Living with high blood pressure

Hypertension is a chronic disease, which means you could be managing or monitoring it throughout your life. By taking steps to live a healthy life and reduce stress, there are options to manage hypertension without medical intervention. If genetics or lifestyle indicate a need for treatment, there are a variety of medications available to help you control high blood pressure and avoid heart attack or stroke.