In “guessing” on the best initial single drug to try, most experts now recommend beginning either with either a thiazide diuretic (usually chlorthalidone or hydrochlorothiazide), a long-acting calcium blocker, or an ACE inhibitor. ARBs are generally thought of as substitutes for ACE inhibitors, and generally, are used only when ACE inhibitors are poorly tolerated.
The new guidelines stem from the 2017 results of the Systolic Blood Pressure Intervention Trial (SPRINT), which studied more than 9,000 adults ages 50 and older who had systolic blood pressure (the top number in a reading) of 130 mm Hg or higher and at least one risk factor for cardiovascular disease. The study's aim was to find out whether treating blood pressure to lower the systolic number to 120 mm Hg or less was superior to the standard target of 140 mm Hg or less. The results found that targeting a systolic pressure of no more than 120 mm Hg reduced the chance of heart attacks, heart failure, or stroke over a three-year period.
Methyldopa, formerly known under the brand name Aldomet, is one of the oldest blood pressure medications still in use. It was first introduced more than 50 years ago. Methyldopa works in the central nervous system to lower blood pressure. While its general use has declined over the years, methyldopa is considered the first-line of treatment for high blood pressure that develops during pregnancy.
Johns Hopkins researchers have identified the genes responsible for aortic ballooning and the sequence of events leading to aortic aneurysms. Dr. Hal Dietz currently conducts clinical trials of therapies for people with inherited aortic aneurysms to improve health and quality of life for these patients.Learn more about Dr. Deitz and his aortic ballooning therapies.
Blood spots in the eyes : Blood spots in the eyes (subconjunctival hemorrhage) are more common in people with diabetes or high blood pressure, but neither condition causes the blood spots. Floaters in the eyes are also not related to high blood pressure. However, an eye doctor (ophthalmologist) may be able to detect damage to the optic nerve caused by untreated high blood pressure.   
If you’re feeling overwhelmed about how to make changes to your diet or if you’re trying to lose weight, you may want to consider working with a registered dietitian-nutritionist (RDN). Some people work with an RDN if they have a health condition like type 2 diabetes. In fact, high blood pressure is a risk factor for type 2 diabetes. This is partly because they share similar modifiable risk factors, like being overweight or obese, following an unhealthy diet, and having a lack of physical activity.

Johns Hopkins researchers have identified the genes responsible for aortic ballooning and the sequence of events leading to aortic aneurysms. Dr. Hal Dietz currently conducts clinical trials of therapies for people with inherited aortic aneurysms to improve health and quality of life for these patients.Learn more about Dr. Deitz and his aortic ballooning therapies.


Quitting smoking. Visit Smoking and Your Heart and the National Heart, Lung, and Blood Institute’s Your Guide to a Healthy Heart [PDF – 2MB]. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
Your blood pressure is said to be “high” when either your systolic blood pressure is 140 or above, or your diastolic blood pressure is 90 or above, or both. So if your blood pressure is found to be 142/88 (systolic = 142, diastolic = 88), you are diagnosed as having high blood pressure, according to current definitions. The same would be true if your blood pressure was found to be 135/92, or 152/95. In each case, either the systolic is high, or the diastolic is high, or both. Any of these findings result in a diagnosis of high blood pressure.
As of 2014, approximately one billion adults or ~22% of the population of the world have hypertension.[137] It is slightly more frequent in men,[137] in those of low socioeconomic status,[6] and it becomes more common with age.[6] It is common in high, medium, and low income countries.[137][138] In 2004 rates of high blood pressure were highest in Africa, (30% for both sexes) and lowest in the Americas (18% for both sexes). Rates also vary markedly within regions with rates as low as 3.4% (men) and 6.8% (women) in rural India and as high as 68.9% (men) and 72.5% (women) in Poland.[139] Rates in Africa were about 45% in 2016.[140]

Oatmeal is one of a few semi-processed foods that lower blood pressure. That’s because getting the right amounts of dietary fiber and whole grains is vital to maintaining normal blood pressure, and oatmeal is a tasty source of both. Classic studies have proven that eating oatmeal can lower systolic and diastolic blood pressure. Plus, the fiber can help you maintain a healthy body weight and prevent obesity, a risk factor for high blood pressure. These are the 10 silent signs you could have low blood pressure.
If you have high blood pressure, it is important to get routine medical care and to follow your prescribed treatment plan, which will include heart-healthy lifestyle changes and possibly medicines. Heart-healthy lifestyle changes can prevent high blood pressure, reduce elevated blood pressure, help control existing high blood pressure, and prevent complications, such as heart attack, heart failure, stroke, vascular dementia, or chronic kidney disease.
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The reasons for this astonishing success are not yet entirely understood. Certainly, two of the major causes of high blood pressure are being addressed: excessive dietary salt is completely eliminated, and it is likely that some patients experience some reversal of the atherosclerosis process. However, Dr. Campbell has suggested that additional mechanisms may be partly responsible for fasting’s remarkable effects, such as the rapid reduction of a phenomenon known as “insulin resistance.”
One reason to visit your doctor regularly is to have your blood pressure checked. Routine checks of your blood pressure will help pick up an early rise in blood pressure, even though you might feel fine. If there's an indication that your blood pressure is high at two or more checkups, the doctor may ask you to check your blood pressure at home at different times of the day. If the pressure stays high, even when you are relaxed, the doctor may suggest exercise, changes in your diet, and, most likely, medications.
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Eat dark chocolate. Dark chocolate and cocoa powder are both full of heart-healthy plant compounds called flavonoids. Flavonoids are good for you because they cause your blood vessels to dilate, which can help lower blood pressure. Just make sure your chocolate doesn’t have too much sugar. Choose chocolate that is at least 70 percent dark for best results. You can buy individually wrapped chocolate pieces that are the perfect size. Eat one or two a day and enjoy the delicious heart-protective effects.

A study shows that drinking 2 cups of a mix of three parts beetroot and one part apple juice can make your systolic blood pressure (the top number) go down in just a few hours. Men may see a bigger benefit than women. High systolic pressure can raise your chances of strokes. Cooked beets and beet greens, which pack lots of potassium, are a good alternative.


For an accurate diagnosis of hypertension to be made, it is essential for proper blood pressure measurement technique to be used.[76] Improper measurement of blood pressure is common and can change the blood pressure reading by up to 10 mmHg, which can lead to misdiagnosis and misclassification of hypertension.[76] Correct blood pressure measurement technique involves several steps. Proper blood pressure measurement requires the person whose blood pressure is being measured to sit quietly for at least five minutes which is then followed by application of a properly fitted blood pressure cuff to a bare upper arm.[76] The person should be seated with their back supported, feet flat on the floor, and with their legs uncrossed.[76] The person whose blood pressure is being measured should avoid talking or moving during this process.[76] The arm being measured should be supported on a flat surface at the level of the heart.[76] Blood pressure measurement should be done in a quiet room so the medical professional checking the blood pressure can hear the Korotkoff sounds while listening to the brachial artery with a stethoscope for accurate blood pressure measurements.[76][77] The blood pressure cuff should be deflated slowly (2-3 mmHg per second) while listening for the Korotkoff sounds.[77] The bladder should be emptied before a person's blood pressure is measured since this can increase blood pressure by up to 15/10 mmHg.[76] Multiple blood pressure readings (at least two) spaced 1–2 minutes apart should be obtained to ensure accuracy.[77] Ambulatory blood pressure monitoring over 12 to 24 hours is the most accurate method to confirm the diagnosis.[78]

Changes in blood vessel structure. Blood vessels have layers of the proteins elastin and collagen. Elastin is what makes blood vessels flexible. Collagen, which is stiffer, gives vessels structure. With age, elastin breaks down. Even the elastin that remains becomes less elastic. Meanwhile, collagen deposits in the vessels increase. As a result, blood vessels grow thicker and bend less easily over time. These changes may lead to higher systolic blood pressure.

Because of the need for emergency care, it is important to recognize the early signs of malignant hypertension. The first giveaway is blood pressure of 180/120. You might have bleeding in the eyes due to rupture of the small blood vessels. Other malignant hypertension symptoms can include chest pain, dizziness, a headache, numbness in your extremities, and confusion.
^ Jump up to: a b c d e f James, PA.; Oparil, S.; Carter, BL.; Cushman, WC.; Dennison-Himmelfarb, C.; Handler, J.; Lackland, DT.; Lefevre, ML.; et al. (Dec 2013). "2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)". JAMA. 311 (5): 507–20. doi:10.1001/jama.2013.284427. PMID 24352797.
^ Jump up to: a b Daskalopoulou, Stella S.; Rabi, Doreen M.; Zarnke, Kelly B.; Dasgupta, Kaberi; Nerenberg, Kara; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain (2015-01-01). "The 2015 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension". Canadian Journal of Cardiology. 31 (5): 549–68. doi:10.1016/j.cjca.2015.02.016. PMID 25936483.

Eat potassium- and magnesium-rich foods. Potassium can help regulate your heart rate and can reduce the effect that sodium has on your blood pressure. Foods like bananas, melons, oranges, apricots, avocados, dairy, leafy green vegetables, tomatoes, potatoes, sweet potatoes, tuna, salmon, beans, nuts, and seeds have lots of potassium.  Magnesium is thought to help blood vessels relax, making it easier for blood to pass through. Foods rich in magnesium include vegetables, dairy, chicken, legumes, and whole grains. It’s better to get vitamins and minerals from food, and a heart-healthy diet like the one we described above is a good way to ensure you get plenty of nutrients. However, you may want to talk to your doctor about whether taking certain supplements might help your blood pressure.

Though essential hypertension remains somewhat mysterious, it has been linked to certain risk factors. High blood pressure tends to run in families and is more likely to affect men than women. Age and race also play a role. In the United States, blacks are twice as likely as whites to have high blood pressure, although the gap begins to narrow around age 44. After age 65, black women have the highest incidence of high blood pressure.


As of 2014, approximately one billion adults or ~22% of the population of the world have hypertension.[137] It is slightly more frequent in men,[137] in those of low socioeconomic status,[6] and it becomes more common with age.[6] It is common in high, medium, and low income countries.[137][138] In 2004 rates of high blood pressure were highest in Africa, (30% for both sexes) and lowest in the Americas (18% for both sexes). Rates also vary markedly within regions with rates as low as 3.4% (men) and 6.8% (women) in rural India and as high as 68.9% (men) and 72.5% (women) in Poland.[139] Rates in Africa were about 45% in 2016.[140]
In most people with established essential hypertension, increased resistance to blood flow (total peripheral resistance) accounts for the high pressure while cardiac output remains normal.[52] There is evidence that some younger people with prehypertension or 'borderline hypertension' have high cardiac output, an elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline hypertension.[53] These individuals develop the typical features of established essential hypertension in later life as their cardiac output falls and peripheral resistance rises with age.[53] Whether this pattern is typical of all people who ultimately develop hypertension is disputed.[54] The increased peripheral resistance in established hypertension is mainly attributable to structural narrowing of small arteries and arterioles,[55] although a reduction in the number or density of capillaries may also contribute.[56]
Note: The fasting and high blood pressure study described in this article was funded in part by a grant from the National Health Association. It was conducted at the Center for Conservative Therapy in Penngrove, California. The results appeared in the article, “Medically Supervised Water-Only Fasting in the Treatment of Hypertension,” published in June 2001 in the Journal of Manipulative and Physiological Therapeutics.
Eat a heart-healthy diet. Eating a well-balanced diet with lots of fruits, vegetables, whole grains, nuts, and seeds that is also low in sodium, saturated fat, added sugar, and cholesterol is important for your heart. There is a diet specifically geared toward lowering blood pressure. It’s called the DASH diet, which stands for dietary approaches to stop hypertension. Talk to your doctor or make an appointment with a dietitian if you need help making changes to your diet.
Strong Heart Study. Since 1988, the NHLBI has supported the Strong Heart Study (SHS), the largest epidemiologic study of American Indians ever conducted. The SHS aims to estimate the impact of heart and blood vessel diseases and to assess how common and significant standard risk factors are in this community. Thirteen tribes and communities in four states participate in the study. Visit Strong Heart Study for more information.
The first chemical for hypertension, sodium thiocyanate, was used in 1900 but had many side effects and was unpopular.[152] Several other agents were developed after the Second World War, the most popular and reasonably effective of which were tetramethylammonium chloride, hexamethonium, hydralazine, and reserpine (derived from the medicinal plant Rauwolfia serpentina). None of these were well tolerated.[159][160] A major breakthrough was achieved with the discovery of the first well-tolerated orally available agents. The first was chlorothiazide, the first thiazide diuretic and developed from the antibiotic sulfanilamide, which became available in 1958.[152][161] Subsequently, beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and renin inhibitors were developed as antihypertensive agents.[158]
People with high blood pressure who drank about eight ounces of beetroot juice experienced a decrease in blood pressure of about 10 mm Hg, according to a study published in April 2013 in the American Heart Association journal Hypertension. The magic ingredient? Nitrate, which turns into nitric oxide, a gas that widens blood vessels and aids blood flow. A glass a day could help keep blood pressure at a lower, healthier level. Here are 31 things you can do right now to avoid high blood pressure.
Most people with high blood pressure are "salt sensitive," meaning that anything more than the minimal bodily need for salt is too much for them and increases their blood pressure. Other factors that can raise the risk of having essential hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and chronic alcohol consumption.

Blood pressure guidelines show the lower the blood pressure numbers the better. As long as no symptoms of trouble are present there is no one number that doctors consider being too low. The guidelines call for an individualized, risk-based approach to managing hypertension, as well as a personal consultation with a health care provider. While the new guidelines mean we are more aggressive about blood pressure control, lifestyle changes are always a part of the treatment plan. A treatment plan is agreed to by patient and provider, and includes ongoing communication to see how the patient is feeling and how their medications are working.
If your blood pressure remains high for a long period of time, you run the risk of damaging your blood vessels. Your stroke risk rises significantly, too. And because your heart is working harder to push blood through your system, that very valuable muscle can become overworked and grow thicker. An enlarged heart causes further complications, including heart failure. Medications and special implantable pumps can help boost heart function. But if you can manage your blood pressure before it gets too high and puts your heart at risk, you may be able to avoid a lot of complications down the road.
The fact that there are so many drugs to choose from means at least two things. First, it means there is no “best” drug for hypertension, that is, there is no drug that works well for almost everyone without causing unacceptable adverse effects. If there were, drug companies would have stopped their efforts to develop new antihypertensive drugs long ago—and the list of approved drugs would be much shorter.
When blood pressure is measured, there are two numbers for each reading: for example, "120 over 80" is written as 120/80. This is because each heartbeat sends a pressure wave through the bloodstream. The higher number (systolic blood pressure) is the peak of the wave, when your heart contracts (the loud "thump" when you listen to your heartbeat). The lower number (diastolic blood pressure) is the lower "dip" or trough of the wave, when your heart relaxes.

In November, the American Heart Association and the American College of Cardiology issued new guidelines that change how high blood pressure, or hypertension, is diagnosed. Previously, it wasn’t until an adult’s blood pressure reached 140 mmHg or higher systolic (the top, or first, number) or 90 mmHg diastolic (the bottom, or second, number) or higher that high blood pressure was diagnosed. According to the new parameters, high blood pressure should be treated at 130/80 rather than 140/90, as that is the point when our risk for heart attack, stroke, and other consequences for hypertension almost doubles.
Blood pressure readings fall into four general categories, ranging from normal to stage 2 high blood pressure (hypertension). The level of your blood pressure determines what kind of treatment you may need. To get an accurate blood pressure measurement, your doctor should evaluate your readings based on the average of two or more blood pressure readings at three or more office visits.

In a hot tub, as the water comes through the pipes, it has a degree of force. This force is caused by the action of the pump, which puts energy into the circulating system and forces the water through the pipes. When the pump is off, there still may be water in the pipes, but there is no force. The degree of force in the system when the pump is on can be gauged in several ways, such as by putting your hand in front of a “jet.” Another way would be to have a device to measure the amount of force that the water exerts against the walls of the pipes as it circulates. Such a device might yield a numerical measurement of the force, or pressure, of the water within the pipes.


Cut down on salt. As you get older, the body and blood pressure become more sensitive to salt (sodium), so you may need to watch how much salt is in your diet. Most of the salt comes from processed foods (for example, soup and baked goods). A low-salt diet, such as the DASH diet, might help lower your blood pressure. Talk with your doctor about eating less salt. 

Johns Hopkins researchers have identified the genes responsible for aortic ballooning and the sequence of events leading to aortic aneurysms. Dr. Hal Dietz currently conducts clinical trials of therapies for people with inherited aortic aneurysms to improve health and quality of life for these patients.Learn more about Dr. Deitz and his aortic ballooning therapies.

Kiwis are another fruit that positively impacts blood pressure. Some researchers studied how the fruit fares compared to apples. They found that eating three kiwis a day over eight weeks reduced blood pressure in people with slightly high blood pressure more so than eating one apple per day during the same time. A daily serving of kiwi was also found to reduce blood pressure in people with only mildly elevated levels. Kiwis are also an excellent source of vitamin C which can also also improve blood pressure. 
African-Americans tend to develop hypertension earlier in life and often experience more severe blood pressure elevation. It is not known for sure why high blood pressure is more common in this group, but researchers theorize it may include higher rates of obesity and diabetes among African-Americans and a gene that makes African-Americans more sensitive to salt. In people who have this gene, even just one-half teaspoon of salt could elevate blood pressure as much as 5 mmHg. (5) 

As of 2014, approximately one billion adults or ~22% of the population of the world have hypertension.[137] It is slightly more frequent in men,[137] in those of low socioeconomic status,[6] and it becomes more common with age.[6] It is common in high, medium, and low income countries.[137][138] In 2004 rates of high blood pressure were highest in Africa, (30% for both sexes) and lowest in the Americas (18% for both sexes). Rates also vary markedly within regions with rates as low as 3.4% (men) and 6.8% (women) in rural India and as high as 68.9% (men) and 72.5% (women) in Poland.[139] Rates in Africa were about 45% in 2016.[140]
It is normal that blood pressure fluctuates during the day. Consecutive measurement will show a circadian rhythm over a 24-hour period. Usually highest reading will be observed in the morning, while lowest readings will be observed in the evening or during the night, when body is at rest. It is also important to note that blood pressure values may be affected by adrenaline, emotions, exercise, sleep patterns and digestion so make sure you pick a good time to do the screening, or otherwise your measurements will not be accurate. It is advisable to repeat the measurement up to three times in a row (with a pause of few minutes in between) to establish a correct value. 
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