There's a good reason why every doctor's appointment starts with a blood pressure check.
Nearly half of American adults have high blood pressure, according to the CDC. But about one in six of them are unaware that they have it because it often doesn't cause any symptoms.
In fact, most people find out they have high blood pressure during a routine office visit.
If left untreated, high blood pressure eventually causes damage to the heart and blood vessels. It can also lead to, worsen or be a sign of many other serious health issues.
The earlier high blood pressure is found, the more easily it can be managed.
Stuart Chen, MD, a cardiologist at Rush, shares some facts you should know about high blood pressure and keeping it under control.
What is blood pressure, and when is it too high?
"Blood pressure is the force of blood pushing against the walls of the arteries in your body as your heart pumps," Chen says.
High blood pressure, also referred to as hypertension, is when that force is too high and begins harming the body.
Your blood pressure is measured in two numbers.
"The systolic blood pressure is the top number," Chen says. "It represents the pressure in the arteries when the heart is pumping. And the bottom number is the diastolic blood pressure. It measures pressure when the heart is resting or relaxed between beats."
Normal blood pressure levels are 120 mmHg/80 mmHg or lower. At risk levels are 120-139 mmHg/80-89 mmHg. Patients with readings of 140 mmHg/90 mmHg or higher usually need further care.
"When it's 130 over 80 or higher, it's considered hypertension or high blood pressure, and medication may be warranted in some cases," Chen says. "And when it's 140 over 90, treatment with medication is generally needed."
Blood pressure is linked to other medical issues.
High blood pressure can be the first sign of a serious underlying problem.
That's why, when a patient comes in with high blood pressure, doctors will often check their urine and kidney function; do an electrocardiogram to check the size of the heart; and look for changes in the lungs.
Stress on the blood vessels makes people with hypertension more likely to develop other serious conditions.
"Over years of uncontrolled high blood pressure, you can have a much higher risk of heart disease, congestive heart failure, stroke and kidney disease," Chen says.
High blood pressure can also lead to heart attacks, peripheral artery disease and aneurysms.
And chronic conditions, like kidney disease, sleep apnea, substance use disorder and obesity can lead to high blood pressure.
"High blood pressure is associated with smoking, alcohol use, lack of exercise or a sedentary lifestyle. Those are some of the big ones," Chen says. "And we see it commonly with patients who have diabetes."
Pregnancy can also contribute to high blood pressure in some patients, leading to a serious complication called preeclampsia.
Postpartum blood pressure typically goes back to normal levels within six weeks. But some who have high blood pressure during more than one pregnancy may be more likely to develop high blood pressure and other heart and vascular diseases as they age.
Lowering systolic blood pressure may cut health risks.
Doctors often used to recommend patients with hypertension aim to cut their systolic blood pressure to below 140 mmHg.
But one major study, called the SPRINT study, found that reaching a systolic blood pressure below 120 mmHg lowered the number of issues such as heart attack, stroke, heart failure and death by about one-fourth among people at least 50 years old with high blood pressure.
Many studies have shown similar evidence, and the American Heart Association has since updated its guidelines. They now recommend adults with hypertension have a systolic blood pressure goal of below 130 mmHg with encouragement to get below 120 mmHg.
That said, your personal blood pressure target depends on a variety of things, including your current blood pressure, lifestyle, risk factors, other medications you are taking and your age.
Not everybody should aim for 120, and trying to do so can cause unintended problems.
It can be dangerous, for example, to keep an older adult on medications commonly prescribed to people with high blood pressure. These include diuretics, or water pills, that can have unsafe side effects, such as dehydration and dizziness.
And there can be other issues involved with taking multiple medications, such as cost and compliance.
"There are higher rates of high blood pressure with different ethnicities and certain diseases, like diabetes and kidney disease," Chen says. "In these cases, closer blood pressure monitoring may be warranted to ensure proper treatment."
Bottom line: If you have high blood pressure, talk to your doctor about what your target should be and how best to achieve it.
You shouldn't ignore white coat hypertension.
Some people experience white coat hypertension. That's when blood pressure is elevated in the doctor's office, but not in other settings.
"It's usually recommended that if your blood pressure is high in the office that we try to track your blood pressure outside of that environment at home," Chen says.
Patients with white coat hypertension should check their blood pressure regularly with an at-home monitor. Another option is to wear an ambulatory monitor that measures blood pressure every 30 minutes for 24 hours.
"That can help determine whether it's a matter of consistent high blood pressure or just abnormal blood pressure in certain rarer circumstances where you might not need immediate treatment with medications," Chen says.
But while white coat hypertension was formerly considered simple nervousness, research suggests otherwise.
Several studies have found that people with white coat hypertension are at greater risk for certain conditions, like sustained high blood pressure, organ damage and diabetes than people who have normal blood pressure.
One possible explanation is that people with white coat hypertension may have a harder time managing stress and anxiety, which can raise blood pressure.
"Chronic stress can lead to chronically elevated blood pressure, but acute stress can also make your blood pressure go up," Chen says. "We see that relatively commonly in a doctor's office when patients have white coat hypertension."
Learning to cope with stress can help.
Stress and hypertension have often been linked, and researchers are still looking into the relationship between the two. The best advice to hypertensive patients: Try to control stress and anxiety.
When you’re stressed, your body sends stress hormones — adrenaline and cortisol — into the bloodstream. These hormones create a temporary spike in blood pressure, causing your heart to beat faster and blood vessels to narrow.
When the stressful situation is over, blood pressure should go back to its normal level. But chronic stress may cause your body to stay in this highly charged state longer than natural.
How you cope with stress also affects blood pressure. For instance, overeating, smoking and drinking alcohol in response to stressful situations are direct causes of sustained high blood pressure.
"We know that substance use, like excessive alcohol use, can lead to high blood pressure," Chen says.
On the flip side, healthier ways of coping, like exercising, practicing yoga and meditating, can all help lower blood pressure.
"The difficulty is managing external triggers," Chen says. "And how to address that is usually to learn how to deal with stress, whether that's breathing treatments or meditation or something that you can do yourself to control how your body reacts when there's an external stressor."
Good sleep can help manage high blood pressure.
"Certainly not having enough sleep, which is a common issue, can lead to poorly controlled blood pressure," Chen says. "Having that recommended seven to eight hours of sleep a day is important."
Most people have a dip in blood pressure during the deepest stage of sleep, also known as slow wave sleep, which is the body's normal and healthy reaction to sleep.
We usually spend 90 minutes to two hours in slow wave sleep per night. Missing out on that deep sleep — and the nighttime dip that comes with — ups the risk for heart disease and may increase daytime blood pressure.
While age and sleep disorders, like sleep apnea or insomnia, can affect the amount of deep sleep you get, there are steps you can take to ensure a good night’s sleep.
Seeing an ENT or sleep medicine specialist can help you treat sleep disorders and get the deep rest to help keep blood pressure low.
"Certain conditions like sleep apnea, where you might intermittently stop breathing while you're sleeping, can be a big stress to your body and your organs, including raising your blood pressure and stress levels," Chen says. "It's important to get that treated because that's a vital component to managing your blood pressure.”
Maintaining a consistent sleep schedule and being more active during the day can also help improve the quality of your sleep.
"These days we have constant distractions, like TV and cell phones," Chen says. "It's important to not have those distractions interfere with getting the right amount of sleep or getting you ready for bed."
Excessive salt raises blood pressure.
Too much sodium can cause water retention that puts increased pressure on your heart and blood vessels.
"Generally, we consider diets that are high in sodium to be a risk factor for hypertension or contribute to elevated blood pressure readings," Chen says. "And that's one of the components of lifestyle management and diet that we think about."
The American Heart Association says people with high blood pressure and those at a high risk for developing it, including adults over 50 and those with diabetes or kidney disease, should have no more than 1,500 milligrams of sodium — less than 3/4 teaspoon of salt — daily.
Even people with normal levels should eat salt in moderation. Stick to no more than 2,300 mg of sodium — about one teaspoon of salt — per day.
The World Health Organization estimates that consuming too much salt led to 1.7 million deaths each year as of 2023.
Most dietary sodium comes from processed foods. The following are a few tips for avoiding excess salt in your diet:
- Choose foods with 5% or less of the daily value of sodium per serving.
- Stick to unprocessed foods. "Opt for a diet that's high in fresh produce, like fruits and vegetables, whole grains and low-fat dairy, and avoid saturated fats," Chen says.
- Fresh or frozen vegetables are better than canned.
- Potassium — found in foods like sweet potatoes, spinach, bananas, oranges, low-fat milk and halibut — can help rid the body of excess sodium.
FAQs about high blood pressure
Q: What are some common causes of high blood pressure spikes?
A: Some people with high blood pressure will experience sharp rises in their blood pressure. These spikes, which typically last only a short period of time, are also known as sudden high blood pressure.
The following are some possible causes:
- Caffeine
- Certain medications (such as nonsteroidal anti-inflammatory drugs) or combinations of medications
- Chronic kidney disease
- Cocaine use
- Collagen vascular disorders
- Overactive adrenal glands
- Pregnancy-related high blood pressure
- Scleroderma
- Smoking
- Stress or anxiety
- Thyroid issues (such as overactive or underactive thyroid gland)
Q: When should I get medical attention for a blood pressure spike?
A: If you have high blood pressure and experience the sudden onset of any of the following symptoms — which may signal a blood pressure spike or other serious condition — seek medical attention right away:
- Blurred vision
- Chest pain, or angina
- Headache
- Coughing
- Nausea or vomiting
- Shortness of breath, or dyspnea
- Weakness or numbness in your arms, legs, face — this can be a sign of stroke
- Anxiety, fatigue, confusion or restlessness
Q: How can I tell if I have high blood pressure?
A: High blood pressure often causes no noticeable symptoms, so it can be hard to tell whether you have it. The best way to know for sure is to make an appointment with your primary care physician or cardiologist who can measure your blood pressure. They can also talk to you about your risks, advise you on how to control your blood pressure and prescribe further treatment if you need it.
Q: Can high blood pressure be genetic?
A: Yes, high blood pressure can be genetic. Studies show that many genes influence blood pressure. Some affect how much your blood vessels constrict or relax, how sensitive you are to salt or the levels of enzymes you produce that affect blood pressure. Sharing your family health history with your physician can help them find out whether testing you for certain genetic traits might be helpful and manage your risks.
Q: How is high blood pressure treated?
A: There are several ways hypertension is treated based on how high a patient’s blood pressure is and how at-risk they are. Patients with moderately elevated blood pressure are often prescribed diet and lifestyle management. This can include cutting out salt and processed foods, quitting smoking and drinking, and exercising more.
Patients with higher blood pressure may be treated with medications. “The common ones that are prescribed are diuretics, or water pills, calcium channel blockers, ACE inhibitors, and angiotensin-receptor blockers” Chen says.
Treatment may also involve managing other conditions that affect blood pressure and increase the risk for heart disease, like diabetes or high cholesterol.
And for patients whose high blood pressure is not well managed with lifestyle changes and medication, also called resistant hypertension, there are newer options.
For example, Rush offers a minimally invasive procedure called renal denervation. It involves inserting a small catheter and delivering radiofrequency or ultrasound energy to the renal arteries — the blood vessels connected to the kidneys. This energy disrupts nerve signals between the kidneys and the brain, which lowers blood pressure.
If you're concerned about your blood pressure, it’s a good idea to make an appointment with a primary care physician or cardiologist. You can call (888) 352-7874 to get an appointment at Rush. You can also learn more on our High Blood Pressure (Hypertension) page.
