An Overview of High Blood Pressure

By Karen Shackelford, MD  

High blood pressure is a condition with serious health consequences that affects up to 80 million American adults. When detected and treated early, however, it can reduce the risk of heart attack, stroke, and kidney disease.

What Is Blood Pressure?

Blood pressure is the outward force that blood exerts on artery walls. Arteries are the blood vessels that carry blood and oxygen from the lungs to all of the organs and tissues of the body.

Arteries are composed of muscle and flexible, elastic connective tissue that stretches to accommodate the force of blood flow generated by the heart. And the pumping action of the heart is what allows blood to travel through these arteries.

Blood pressure is expressed in two numbers. The top number, systolic blood pressure, reflects the force generated by the contractions of the heart. The bottom number, the diastolic blood pressure, refers to the pressure of blood against the walls of the arteries when the heart is resting between contractions.

The Numbers

After the age of 20, all adults should begin to monitor their blood pressure at their regular healthcare visits. If you are older than 40 or have risk factors for high blood pressure, you should have your blood pressure checked in both arms at least annually. It’s important to use the correct size blood pressure cuff, which is why it may not be adequate to check your blood pressure in an automatic machine at the pharmacy or grocery store.

Normal blood pressure is considered to be less than 120/80 mm Hg. With 24-hour monitoring or frequent home blood pressure monitoring, daytime normal blood pressure is defined as an average blood pressure less than 135/85 mm Hg.

If your numbers are higher than this, it does not mean you have high blood pressure. Blood pressure can change in response to exercise, stress, medication, illness, and even the time of day. It’s important to take several readings over time in order to make an appropriate diagnosis.


Most adults with high blood pressure have primary hypertension, previously called “essential” hypertension. This simply means that the elevation in blood pressure is not due to any other cause. Primary hypertension gradually develops over several years. Unless you monitor it, you may never even be aware that you are experiencing a problem that could lead to significant organ damage.

Secondary hypertension refers to hypertension that is caused by another condition or medication. In most cases, secondary hypertension occurs suddenly and may cause greater elevation in blood pressure than primary hypertension. Thyroid disorders, kidney disease, obstructive sleep apnea, alcohol abuse, illegal drugs, and tumours of the adrenal gland are some of the causes of secondary hypertension.

Risk Factors

There are a variety of factors that can increase your risk of high blood pressure. Some risk factors cannot be modified but others can be reduced with changes in diet and lifestyle. Risks that can’t be modified include age, family history, and race. For example:

After the age of 45, men are more likely to develop high blood pressure.

In women, the risk increases after the age of 65.

African Americans are at greater risk of hypertension which tends to develop earlier and cause more serious complications.

Modifiable risk factors include:

  • Being overweight
  • A sedentary lifestyle
  • Tobacco use
  • A high sodium or low potassium diet
  • Excessive alcohol intake
  • Lack of vitamin D
  • Stress can also increase blood pressure temporarily and, over time, lead to chronic hypertension.

Although children are at lower risk of developing essential hypertension, they can develop high blood pressure as a result of other conditions. A child’s blood pressure should be measured at each annual check-up and compared to other children of the same age group.


Blood pressure readings can fall into one of five categories:

Prehypertension. If your systolic blood pressure is between 120-139 mm Hg or if your diastolic blood pressure reading is between 80 and 89 mm Hg, you may have prehypertension. Prehypertension, like high blood pressure, carries an increased risk of cardiovascular disease and typically worsens over time. Treatment includes non-pharmacological measures, such as weight reduction, increased physical activity, avoiding excess alcohol, and restricting salt intake.

Stage I hypertension. This refers to a systolic blood pressure of 140 mm Hg to 159 mm Hg or a diastolic blood pressure of 90 to 99 mm Hg. If only one of these values is elevated, then the higher value determines the severity of hypertension. This will lead to determination of the appropriate treatment.

Isolated Systolic/diastolic hypertension. Patients with a systolic blood pressure greater than 140 mm Hg and a diastolic pressure of less than 90 mm Hg are considered to have isolated systolic hypertension. Those with a diastolic pressure greater than or equal to 90 mm Hg but with a systolic pressure less than 140 mm Hg are considered to have isolated diastolic hypertension. The systolic blood pressure is the best predictor of risk in individuals over the age of 60. Studies show that there are significant benefits to treating blood pressure, particularly in patients with mild hypertension. Current recommendations suggest that blood pressure medication be initiated in patients with stage I hypertension, although it should be started earlier in people who have heart disease, diabetes, or chronic kidney disease.

Stage II hypertension. This refers to more hypertension, with a systolic pressure of 160 mm Hg or greater or a diastolic pressure of 100 mm Hg or greater. Stage II hypertension may initially require more than one medication for treatment.

Malignant hypertension. This refers to extremely high blood pressures, over 180 mm Hg systolic or 120 mm Hg diastolic, that develop quickly and produces end-organ damage. Malignant hypertension is a condition that requires immediate medical care. This condition is also known as hypertensive urgency or hypertensive emergency. Symptoms may occur as a result of organ damage, including confusion or mental status changes, blurred vision, seizures, shortness of breath, swelling, and chest pain due to angina, heart attack, or aneurysm.


The United States Preventive Services Task Force recommends ambulatory blood pressure measurement for accurate diagnosis of hypertension. Although you may have elevated blood pressure when measured in your doctor’s office, this can be the result of “white coat hypertension.” Screening by your healthcare provider may also miss “masked hypertension.” 12- and 24-hour average blood pressures using ambulatory blood pressure monitoring are often significantly different from readings taken in a clinic or hospital setting and result in fewer patients requiring treatment, with significantly fewer patients requiring treatment as a result. Other patients may have elevated blood pressure averages discovered with ambulatory monitoring that place them at risk for stroke and cardiovascular disease even when the readings obtained in a healthcare setting are normal.

If you are diagnosed with hypertension, your physician or healthcare provider may order laboratory tests to determine whether or not there is a secondary cause, such as a thyroid abnormality or abnormality of the adrenal gland. Other blood tests will measure electrolyte levels, creatinine, and blood urea nitrogen to determine if your kidneys are involved.

Urinalysis is another test often used to diagnose kidney damage as a result of blood pressure and to rule out kidney disorders that can be a secondary cause. Lipid profiles measure your cholesterol levels and are used to assess your risk of cardiovascular diseases like heart attack and stroke. Imaging studies are used to identify possible tumours of the adrenal glands or damage to the kidneys.

If you are diagnosed with hypertension, you will also need an eye examination. An examination with an ophthalmoscope can determine the effect your blood pressure has had on the blood vessels in the eye and whether or not your retina has sustained damage.

In addition to an electrocardiogram (ECG) to evaluate possible heart damage, an echocardiogram may be used to see if your heart has become enlarged or if you have other cardiac problems related to hypertension, like blood clots or heart valve damage. Doppler ultrasound examination can be used to check the blood flow through the arteries to determine if they have narrowed, thus contributing to high blood pressure.


The initial treatment for hypertension includes changes in lifestyle and diet to eliminate or reduce contributory factors like obesity or a high sodium diet. Smoking cessation and reduction of alcohol use—one drink a day for women and two drinks a day for men—are important steps for the reduction of blood pressure.

Your doctor will probably recommend regular aerobic exercise which has a beneficial effect on blood pressure. Evidence shows that brisk walking for at least 30 minutes daily several times a week is beneficial for blood pressure reduction.

There are also a number of different medication classes available for the treatment of hypertension. The JNC 8 recommendations for treatment of blood pressure are based on evidence from multiple studies in many different populations. People with stage II hypertension may need initial treatment with two medications or a combination drug.

Follow-up is important. If your blood pressure goal has not been achieved after a month of treatment, your healthcare provider may increase your dose or add a different class of medication. After you reach your blood pressure goal, you must continue to monitor your response to treatment and development of any other conditions in order to prevent the progression of problems.


There are significant consequences to chronic hypertension:

  • Heart attack
  • Stroke
  • Aneurysms
  • Heart failure
  • Kidney failure
  • Damage to blood vessels
  • Cognitive and memory problems
  • Eye damage and vision loss
  • Metabolic syndrome

The damage is cumulative over time. High blood pressure is rarely associated with symptoms, so it is often left untreated or overlooked until permanent and devastating organ damage has occurred. When blood pressure is increased, the walls of the arteries may become injured or stretched. Damage to the blood vessels can create weak regions that give rise to aneurysms or rupture.

Damage to the heart muscle can also cause atrial fibrillation over time. Atrial fibrillation is an irregular heart rate that puts you at risk for stroke. High blood pressure can also tear the inner layer of the arteries, allowing the buildup of scar tissue that attracts cholesterol debris and platelets (blood cells that form clots). Cholesterol build-up in damaged blood vessels is called a plaque. These plaques cause a narrowing of the arteries, which results in more work for the heart to pump adequate blood through the body.

Plaque can rupture under high pressure. This causes platelets to adhere and form a clot that can break off and travel throughout blood circulation, blocking oxygenated blood from reaching critical tissues. Additionally, these clots may break off and travel to other parts of the body, blocking blood flow and causing heart attacks or stroke. Clot formation also narrows the artery, making the heart work harder to pump blood with oxygen throughout the body.

Damage to the arteries from high blood pressure, including scarring and cholesterol build-up, results in a stiffening of the arteries. This causes the heart to work harder to push blood throughout the body. The heart is a muscle, and over time, it will become damaged and floppy as a result of high blood pressure. The chambers of the heart will enlarge and the muscular fibers will not be able to contract adequately to compensate, resulting in heart failure.

A Word From Verywell

Hypertension is a serious chronic disorder that can cause many harmful health effects over time. If you are an adult over the age of 20, you should have your blood pressure checked by your healthcare provider at your regular health visit. If you are over the age of 40, it’s important to have your blood pressure checked annually. Remember, the reading you get from a manual machine or at the pharmacy may not be accurate.

Detecting high blood pressure early can prompt you to make healthy changes in your diet and lifestyle that will reduce your risk of serious disorders like stroke or heart attack. If you fall in a high-risk category, have your blood pressure checked today.



Written By: Cure HBP

Drugs that treat high blood pressure are either short-acting or long-acting. The former won’t control blood pressure throughout the day. To do this, you have to increase the dosage or take it several times a day.

In contrast, long-acting drugs can control your blood pressure much longer much longer or as much as 24 hours. You simply take one tablet at the prescribed time each day and get on with your life.

At first, doctors thought it didn’t matter whether you took one or the other. After all, both of these drugs lowered blood so what more could a physician ask?

However, recent studies show that not all antihypertensive can protect you from the complications of hypertension even if they lower blood pressure. While short-acting agents can make your blood pressure drop, the effects of these drugs vary greatly throughout the day – like a Ping-Pong ball bouncing up and down. Obviously, that’s to be expected when you’re playing Ping-Pong – but not when you’re treating hypertension.

These concerns were aired during the 16th Scientific Meeting of the International Society of Hypertension (ISH) in Glasgow in the United Kingdom. Dr. John P. Chalmers, ISH president, said the “Ping-Pong effect could lead to a rapid fall in blood pressure (hypotension), tachycardia (rapid heart beat), and other cardiac problems.

The same view is shared by Dr. Henry L. Elliot of the Department of Medicine and Therapeutics at the Gardiner Institute in Glasgow who said that short-acting drugs don’t seem to offer any protection against overnight hypertension and the subsequent rise in cardiovascular risk during the waking and early working part of the day.

This is bad news for people with hypertension since those with greater blood pressure (BP) variability appear to be at higher risk for end-organ damage, according to Dr. Gianfranco Parati, associate professor of cardiology at the University of Milan in Italy. Parati said that the more your BP varies throughout the day, the greater your chances of suffering from cardiovascular complications.

To avoid this problem, the U.S. Food and Drug Administration (FDA) said that drugs used to treat hypertension should not only lower BP but, more importantly, prevent fluctuations in BP which appear to be related to cardiovascular complications.

Because of their limited effects, short-acting drugs don’t meet these criteria. The FDA also warned against the use of high doses of short-acting antihypertensive to maintain smooth blood pressure levels for 24 hours since this could counteract the benefits of lower pressure.

Experts say the ideal antihypertensive should be long-acting with a continuous therapeutic effect that can be given once a day yet control BP for 24 hours before the next dose is taken. This will ensure that your BP levels remain stable throughout the day.

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The new technology, detailed in a paper in the journal Science Translational Medicine, also includes the discovery of a more convenient measurement point.

“We targeted a different artery, the transverse palmer arch artery at the fingertip, to give us better control of the measurement,” says lead author Anand Chandrasekhar, electrical and computer engineering doctoral student at Michigan State University. “We were excited when we validated this location. Being able to use your fingertip makes our approach much easier and more accessible.”

The approach uses two sensors: an optical sensor on top of a force sensor. The sensor unit and other circuitry are housed in a 1 centimeter-thick case attached to the back of the phone. Users turn on the app and press their fingertip against the sensor unit. With their finger on the unit, they hold their phone at heart level and watch their smartphone screen to make sure they’re applying the correct amount of finger pressure.

“A key point was to see if users could properly apply the finger pressure over time, which lasts as long as an arm cuff measurement,” says senior author Ramakrishna Mukkamala, electrical and computer engineering professor. “We were pleased to see that 90 percent of the people trying it were able to do it easily after just one or two practice tries.”

Internationally, thes device could be a game-changer, researchers say. While high blood pressure is treatable with lifestyle changes and medication, only around 20 percent of people with hypertension have their condition under control.

The new invention gives patients a convenient option, and keeping a log of daily measurements would produce an accurate average, discounting an occasional measurement anomaly, Mukkamala says.

The research team will continue to improve accuracy and hopes to pursue more comprehensive testing based on the standard protocol of the Association for the Advancement of Medical Instrumentation. The scientists are already making inroads to build improved hardware. Future iterations could be as thin as 1 millimeter and be part of a standard protective phone case.

Other researchers from Michigan State and from the University of Maryland contributed to the work. The National Institutes of Health and MSU supported the study.

Source: Michigan State University

Original Study DOI: 10.1126/scitranslmed.aap8674





Community programs for the prevention of cardiovascular disease have generally succeeded in lowering blood pressure (BP) and improving cardiovascular health in the general population. They have also met the challenge of raising awareness, increasing knowledge, and promoting changes in health behavior. Moreover, they have likely contributed to the improved rates of BP control among hypertensive patients in North America over the past 2 decades. Successful population-based interventions combined the power of mass media and other communication tools with screening and counselling activities. These targeted BP programs were firmly rooted in sound scientific evidence that interventions to lower BP improve health outcomes. The study by Salazar et al. adds another dimension to population-based programs by highlighting the importance of sustained public health activity to maintain good BP control. These investigators demonstrated that individuals whose BP rose during the community intervention were at higher risk of developing a cardiovascular event.

The new challenge for hypertension programs is maintaining community interest while reiterating the same health messages. A recent measles outbreak among unvaccinated adults in Canada has shown that in the absence of constant reminders, memories about serious preventable illnesses fade. To communicate effectively, community hypertension programs will need to borrow heavily from the world of technology about packaging messages to meet the changing ways that the general population consumes information.  Public health interventions will need to take into account the new communication tools and fashion messages that fit the constraints of these instruments. It has amply been demonstrated that multiple approaches are required and communication strategies differ markedly among the target population to be reached. Interventions must also tap into risk factors that are products of the changing lifestyle of the community. It is apparent that lifestyle messages need to adapt to the reality of more prolonged periods of sitting at work, decreased time for meal preparation, financial constraints requiring dual-earner partnerships, and more fragmented and disrupted sleep. New public health approaches need to be rigorously evaluated to ensure that they are both cost-effective and applicable to large segments of the population. In the past, several well-thought-out, community-wide strategies for cardiovascular disease prevention, when properly evaluated, proved to have modest or no effect, leading the investigators to conclude that there was a need for new designs and new interventions.

We are now living in an age where telecommunication systems allow individuals easy access to reliable health information anytime, anywhere. Networks using 3G and 4G technology enable high-speed data transfer and support a wide variety of information technology platforms. This new technology provides patients with direct access to personal health records, web portals, and healthcare providers. Presently, it is unclear what system works best and whether there are differences between countries. There are trials demonstrating the benefits of telecommunication in both developed and developing countries.

Wireless connectivity is growing rapidly, and mobile devices are replacing landlines, desktop computers, and workstations as the preferred method of communication. The sale of smartphones with built-in messaging systems now outstrips that of cell phones. The recent flood of mobile healthcare devices and software applications has greatly expanded self-care capabilities across the spectrum of healthcare activities. Apart from ubiquitous educational materials, there is a cornucopia of self-help wellness and fitness programs for individuals interested in maintaining or improving their health. There is also a wide range of mobile services and solutions to prevent, diagnose, and treat diseases. Mobile health applications running on wireless devices facilitate disease monitoring.They enable remote monitoring of vital parameters to ensure health maintenance and provide early signals of potentially dangerous trends away from good health. Sleek wearable medical technology, now highly fashionable, allows individuals to monitor a wide array of vital signs and symptoms effortlessly and unobtrusively. Many such devices have built-in Bluetooth capabilities to transmit the data to a secure online database using a protected Internet connection, which in turn provides immediate feedback to users.

In the past decade, there has been a shift away from the traditional medical model of healthcare delivery to a more personalized system in which individuals are encouraged to participate in health maintenance activities and, for those with health problems, to work collaboratively with their healthcare providers. In the new paradigm, community resources, and policies are integrated more closely into the health system to ensure that programs have a broad reach yet provide needed support for targeted activities. The effectiveness of this combined approach was recently demonstrated in a randomized controlled trial of a multipronged, community-based health promotion and prevention program for cardiovascular disease. The intervention, which targeted older adults, engaged public health units, community physicians, and local health organizations, significantly improved cardiovascular risk factor management, and reduced morbidity at the population level. An essential element of the study’s intervention was self-management support.

There are many domains of health under personal control. Individuals can easily learn self-care skills, become more knowledgeable about health matters, modify poor lifestyle choices, use monitoring tools that track vital health parameters, and identify ways of preventing or mitigating the effects of the disease. Interactive technologies and online resources such as social networks, video chat, and instant messaging platforms facilitate these self-help behaviours and are successfully filling gaps in the current health systems. Through social media, individuals can find or create networks with peers to share common experiences, increase problem-solving skills and gain confidence in making life-improving changes. Such interactions build a strong sense of belonging and encourage participation in communal efforts to combat health problems in targeted groups. These developments are encouraged by the US Institute of Medicine and strongly endorsed by academic leaders in the United States.

If information technology is an important key to the future of community-based programs for chronic conditions such as hypertension, it faces many challenges. Foremost, it needs to appeal to all stakeholders, including organizations representing professionals, academic and research institutions, industry, and representatives from the general public. Age is a potential barrier in building successful interventions that use health information technology. The targeted population for hypertension is mostly aged >50 years and, in general, newly acquiring the skills to use the Internet and mobile devices. Nonetheless, the number of users in this age bracket is growing rapidly. A 2010 survey by the American Association of Retired Persons found that most were comfortable using a mobile phone and 7% even had a smartphone. Furthermore, older adults are interested in acquiring the skill to use a mobile health system to track vital signs such as BP and weight. For educators, it is important to recognize that many features of mobile devices are not intuitive for users aged >50 years and developing that intuition takes time. To increase acceptability of mobile health systems for older adults who are more likely to have a hearing, vision, cognition, and mobility problems, developers need to avoid design features such as small buttons and dim screens that impede usability. Apart from age and design issues, other impediments to the use of mobile health technology include affordability and availability that may reduce access. Such barriers are not insurmountable and are amenable to thoughtful solutions such as the use of publically available devices.

In summary, there is a growing body of evidence that community programs reduce BP and improve cardiovascular health in the general population.  Assessments of cardiovascular risk factors by the World Health Organization MONICA project from the mid-1980s to mid-1990s and by the National Health and Nutrition Examination Survey from 1971 to 2010 provide additional support for population-based interventions. Both surveys showed a leftward shift in the frequency distribution of BP. Importantly, the decrease in BP occurred equally at all levels of readings, indicating that the change was not specifically related to better clinical management of hypertension and the increasing application of antihypertensive medications. This evidence, along with the new findings of Salazar et al., justifies supporting community efforts to improve the management of cardiovascular risk factors. For continued success, however, community programs will need to take into account the changing way healthcare is being delivered and incorporate the advances in mobile communication technology and social media in program planning.


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