Elevated blood pressure

Overview

Elevated blood pressure is blood pressure that is slightly higher than what is considered ideal.

Blood pressure is measured in millimeters of mercury (mm Hg). The American College of Cardiology and the American Heart Association divide blood pressure into four general categories.

• Normal blood pressure. Blood pressure is lower than 120/80 mm Hg.
• Elevated blood pressure. The top number ranges from 120 to 129 mm Hg and the bottom number is below (not above) 80 mm Hg.
• Stage 1 hypertension. The top number ranges from 130 to 139 mm Hg or the bottom number is between 80 to 89 mm Hg.
• Stage 2 hypertension. The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.

Elevated blood pressure is considered a category, not an actual health condition like high blood pressure (hypertension). But elevated blood pressure tends to get worse over time unless it's properly managed. That's why it's important to regularly check and control your blood pressure. Healthy lifestyle habits, such as regular exercise and a healthy diet, can help prevent and control high blood pressure (hypertension).

Uncontrolled, elevated blood pressure and hypertension increase the risks of heart attacks and strokes. Some research says long-term elevated blood pressure can lead to changes in memory, language, thinking or judgment (cognitive decline).

Symptoms

Elevated blood pressure doesn't cause symptoms. The only way to detect it is to have regular blood pressure checks. Have your blood pressure measured when you visit your health care provider. You can also check it at home with a home blood pressure monitoring device.

When to see a doctor

A child's blood pressure should be checked during routine well-check appointments starting at age 3. If the child has high blood pressure, a measurement should be taken at every follow-up appointment.

Adults age 18 and older should have a blood pressure check at least every two years. You or your child might need more-frequent checks if you have elevated blood pressure or other risk factors for heart disease.

Causes

Anything that increases pressure on the artery walls can lead to elevated blood pressure. A buildup of fats, cholesterol, and other substances in and on the artery walls (atherosclerosis) can cause elevated blood pressure. But the opposite is also true. High blood pressure (hypertension) can cause atherosclerosis.

Sometimes, the cause of the elevated or high blood pressure isn't identified.

Conditions and medications that can cause elevated blood pressure include:

• Adrenal gland disorders
• Heart problem affecting blood vessels present at birth (congenital heart defect)
• Illegal drugs, such as cocaine and amphetamines
• Kidney disease
• Obstructive sleep apnea
• Some medications, including birth control pills, cold and sinus medicines, over-the-counter pain relievers containing caffeine, and some prescription drugs
• Thyroid disease

Talk to your health care provider about all the medicines you take, including those bought without a prescription.

Risk factors

Anyone can have elevated blood pressure, even children.

Risk factors for elevated blood pressure include:

• Obesity or being overweight. Obesity makes you more likely to have high blood pressure. High blood pressure is a risk factor for heart disease and strokes.
• Family history of high blood pressure. You're more likely to develop elevated blood pressure if you have a parent or sibling with the condition.
• Not being physically active. Not exercising can cause weight gain. Increased weight raises the risk of elevated blood pressure.
• Diet high in salt (sodium) or low in potassium. Sodium and potassium are two nutrients that the body needs to control blood pressure. If you have too much sodium or too little potassium in your diet, you may develop elevated blood pressure.
• Tobacco use. Smoking cigarettes, chewing tobacco or being around smoke (secondhand smoke) can increase blood pressure.
• Drinking too much alcohol. Alcohol use has been linked with elevated blood pressure, particularly in men.
• Certain chronic conditions. Kidney disease, diabetes and sleep apnea, among others, can increase the risk of elevated blood pressure.
• Age. Simply getting older raises the risk for increased blood pressure.
• Race. Elevated blood pressure is particularly common among Black people and usually develops at an earlier age than it does in white people.

Although elevated blood pressure and high blood pressure are most common in adults, children can get it, too. For some children, kidney or heart problems can cause high blood pressure. Poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to increased blood pressure in kids.

Complications

Elevated blood pressure can worsen and develop into long-term high blood pressure as a health condition (hypertension). Hypertension can damage body organs. It increases the risk of heart attacks, heart failure, strokes, aneurysms and kidney failure.

Prevention

The same healthy lifestyle changes recommended to treat elevated blood pressure also help prevent it. Eat healthy foods, use less salt, don't smoke, exercise regularly, maintain a healthy weight, avoid or limit alcohol, and manage stress.

Diagnosis

A blood pressure test is done to diagnose elevated blood pressure. A blood pressure test may be done as a part of a routine health checkup or as a screening for high blood pressure (hypertension).

Blood pressure is measured in millimeters of mercury (mm Hg). A blood pressure measurement has two numbers:

• The top number (systolic) is the pressure of the blood flow when the heart muscle squeezes (contracts), pumping blood.
• The bottom number (diastolic) is the pressure in the arteries measured between heartbeats.

Elevated blood pressure is a measurement of 120 to 129 mm Hg and a bottom number below (not above) 80 mm Hg.

A diagnosis of elevated blood pressure is based on the average of two or more blood pressure readings. The measurements should be taken on separate occasions in the same way. The first time your blood pressure is checked, it should be measured in both arms to determine if there's a difference. After that, the arm with the higher reading should be used.

A longer blood pressure monitoring test can be done to check blood pressure at regular times over six or 24 hours. This is called ambulatory blood pressure monitoring. However, the devices used for the test aren't available in all medical centers. Check with your insurer to see if ambulatory blood pressure monitoring is a covered service.

Your provider might also suggest that you check your blood pressure at home. Home blood pressure monitors are available at local stores and pharmacies. Some devices store the measurements in its memory.

Tests

If you have elevated or high blood pressure, your health care provider may do blood and urine tests to check for conditions that can cause it. Tests may include:

• Complete blood count
• Cholesterol test (lipid profile)
• Blood sugar (glucose) test
• Kidney function tests
• Thyroid function tests

Other tests may also be done.

You might also have an electrocardiogram (ECG/EKG) to check how the heart is beating. An ECG is quick and painless. During an ECG, sensors (electrodes) are attached to the chest and sometimes to the arms or legs. Wires connect the sensors to a machine, which prints or displays results.

Treatment

Healthy lifestyle changes are recommended for anyone with elevated or high blood pressure.

If you have elevated blood pressure and diabetes, kidney disease or heart disease, your provider might also recommend blood pressure medication.

If you have elevated blood pressure but don't have any heart disease risk factors, the benefits of medication are less clear.

Treatment for stage 1 or stage 2 hypertension usually includes blood pressure medications and healthy lifestyle changes.

Self care

As blood pressure increases, so does the risk of heart disease. That's why it's so important to control elevated blood pressure. The key is a commitment to healthy lifestyle changes. Try these tips:

• Eat healthy foods. Eat a healthy diet. Try the Dietary Approaches to Stop Hypertension (DASH) diet. Choose fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. Get plenty of potassium from natural sources, which can help lower blood pressure. Eat less saturated fat and trans fat.
• Use less salt (sodium). Processed meats, canned foods, commercial soups, frozen dinners and certain breads can be hidden sources of salt. Check food labels for the sodium content. Aim to limit sodium by at least 1,000 milligrams (mg) a day. A lower sodium intake — 1,500 mg a day or less — is ideal for most adults.
• Manage weight. Losing weight if you're overweight or have obesity can help control blood pressure and lower the risk of complications. Ask your health care provider what weight is best for you. In general, blood pressure drops by about 1 mm Hg with each kilogram (about 2.2 pounds) of weight lost. In people with high blood pressure, the drop in blood pressure may be even more significant per kilogram of weight lost.
• Increase physical activity. Regular exercise keeps the body healthy. It can lower blood pressure, ease stress, manage weight and reduce the risk of chronic health conditions. Aim to get at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of the two.
• Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
• Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your care provider for strategies to help you quit.
• Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to reduce stress.

Preparing for your appointment

If you think you may have elevated or high blood pressure, make an appointment with your family care provider to have your blood pressure checked.

No special preparations are necessary. To get an accurate blood pressure reading, avoid caffeine, exercise and tobacco for at least 30 minutes before the test.

Because some medications can raise blood pressure, bring a list of all medications, vitamins and other supplements you take and their doses to your medical appointment. Don't stop taking any prescription medications that you think might affect your blood pressure without your provider's advice.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms, if you have any, even if they seem unrelated to the reason you scheduled the appointment, and when they began
• Important personal information, including any family history of high blood pressure, high cholesterol, heart disease, stroke or diabetes, and any major stresses or recent life changes
• Write down questions to ask your provider.

For elevated blood pressure, questions to ask your health care provider include:

• What tests do I need?
• Do I need to take medication?
• What foods should I eat or avoid?
• What's an appropriate level of physical activity?
• How often do I need to have my blood pressure checked?
• Should I check my blood pressure at home?
• I have these other health conditions. How can I best manage them together?
• Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, including:

• What are your diet and exercise habits like?
• Do you drink alcohol? How many drinks do you have in a week?
• Do you smoke?
• When did you last have your blood pressure checked? What was the result?