What you don't know can affect you

Despite its name, hypertension, or high blood pressure, doesn't have anything to do with hyperactivity, nervousness, or being tense. In fact, you can be a calm and relaxed person and still have hypertension. Many people who have high blood pressure don't even know it.

And that's what makes it so dangerous. High blood pressure is called the "silent killer" because it has no symptoms. Without regular medical screening, this condition may go undetected until vital organs are damaged. Although there is no cure for hypertension, there are many proven ways to control it. Medication, diet, exercise, and stress reduction are the major remedies that can reduce the risk of this serious, potentially life-threatening disease.

Detailed Description

Blood pressure is the result of two forces:

  • Force created by the heart as it pushes blood into the arteries and through the circulatory system
  • Force of the arteries as they resist the blood flow

Your blood pressure is not a constant figure. It varies naturally with activity, weight, age, and even time of day. Infants and children generally have lower blood pressure; adults, with their larger bodies, have higher pressures. Your readings may also be highest in the morning and lowest when you sleep.

Hypertension comes into the picture when the pressure in your arteries increases to unsafe levels. High blood pressure is measured in the weight of a column of mercury (mm Hg) and is determined by two readings:

  • The first value, systolic, measures maximum pressure, when the heart is at work (beating)
  • The second value, diastolic, measures minimum pressure, when the heart is at rest (between beats)

For an adult, a normal systolic reading is in the 100 to 135 mm Hg range. Normal diastolic pressure should be from 60 to 80 mm Hg. When you have your blood pressure checked, you will be given the systolic reading over the diastolic. A common normal reading is 100/75 or 110/80 and so on. The greater these readings — especially the diastolic value — the greater the threat to your health. Thus, a blood pressure reading above 140/90 requires monitoring and possible further evaluation by your doctor.

How Common Is Hypertension?

The American Heart Association estimates that as many as 50 million Americans have high blood pressure. That works out to one in five Americans (and one in four adults), and more than 31% of them don't know they have it. High blood pressure occurs more often in African-Americans, and at any given blood pressure level, the consequences of high blood pressure are worse in African Americans.

Conventional Treatment

Goals of Treatment

The goal of treatment for hypertension is to reduce high blood pressure readings to a normal range — below 140/90. Primary hypertension, the most common type, is incurable. However, with proper treatment, it can be effectively controlled, thus reducing the risk factors associated with other, possibly fatal conditions. In secondary hypertension, the specific medical reason for the increased blood pressure can be identified and possibly corrected, sometimes with surgery.

Treatment Overview

Mild hypertension can be controlled quite well through adjustments in your diet and lifestyle:

  • If you smoke, stop. Nicotine constricts arteries and raises your blood pressure.
  • Lose weight if necessary. Obesity affects hypertension.
  • Reduce the amount of salt in your diet to less than 2.3 grams of sodium or 6 grams of sodium chloride per day.
  • Cut back on alcohol. Drinking two or more ounces of alcohol a day can raise your blood pressure. That's the amount typically found in four ounces (two shots) of 100-proof whiskey, 16 ounces (two glasses) of wine, or 48 ounces (four cans or bottles) of beer.
  • Exercise regularly.
  • Lower your stress level.

If your hypertension is moderate to severe, many medications are available to help control it. Often, your physician may prescribe a combination of treatments.

Drug Therapy

Drugs most commonly prescribed

Depending on the severity of your hypertension, a combination of drugs may be necessary, although at least 50% of all hypertension cases (irrespective of race, gender, or age) are effectively managed through a program using a single antihypertensive drug. The list of medications is extensive, but nine major categories are relevant, which classify the drugs based on their method of action. These functionally distinct categories are:

  • Diuretics
  • Beta-blockers
  • Alpha-blockers
  • Alpha/beta-blockers
  • Calcium-channel blockers
  • Angiotensin converting enzyme (ACE) inhibitors
  • Vasodilators
  • peripherally and centrally acting drugs

Like most drug therapy programs, drug treatment for hypertension can cause side effects. Common symptoms may include sedation, impotence, dizziness, fatigue, nightmares, and depression.

The categories are listed below followed by a short description and a list of commonly prescribed drugs.


Diuretics increase the removal of salt and water from the body, leading to an overall decrease in body fluids and a reduction in blood pressure. They have proven especially to be effective for treating hypertension in African-American and elderly populations. However, the majority of these drugs can lower potassium levels possibly resulting in such symptoms as leg cramps, muscle weakness, and muscle spasms. Alternatives to the potassium-wasting diuretics are potassium-sparing diuretics or including a daily potassium supplement and potassium-rich foods in your diet to prevent potassium deficiency.


On-Label Efficacy


On-Label Efficacy

These drugs interfere with nerve receptors in your heart and cause it to beat less forcefully, thereby reducing the amount of blood pumped during each beat. This causes a reduction in your blood pressure. Most older patients respond very well to beta-blockers. One study indicated that the beta-blocker class was the most effective antihypertensive drug class in older Caucasian patients. This is also an appropriate treatment for young patients. These drugs are not as effective in African-American patients and should be avoided by those suffering from asthma, insulin-dependent diabetes, peripheral vascular disease, or congestive heart failure (CHF) caused by systolic dysfunction.


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy
Calcium channel-blockers

This antihypertensive drug prevents the influx of calcium into arteriole muscle cells which renders them unable to maintain a contraction. This facilitates increased blood flow resulting in reduced blood pressure. These drugs have proven as effective monotherapy in African-American populations.


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy
Angiotensin-converting enzyme (ACE) inhibitors

This drug inhibits the production of angiotensin II, a chemical that causes arteriole wall contraction. These drugs cannot be taken during pregnancy.


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy
Angiotensin converting enzyme receptor blockers

These drugs block the vasoconstrictor and aldosterone-secreting effects of angiotensin II by blocking the binding of the angiotensin II receptor.


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy

These drugs block receptors located on blood vessel walls that, when stimulated, cause contraction, thereby increasing blood flow and lowering blood pressure.


On-Label Efficacy


On-Label Efficacy


On-Label Efficacy
Alpha/beta adrenergic-blockers


On-Label Efficacy
Direct vasodilators

These drugs act directly on blood vessels, causing them to relax and dilate.


On-Label Efficacy


On-Label Efficacy
Centrally acting drugs

These drugs lower blood pressure by reducing nerve impulses from the brain.


On-Label Efficacy


On-Label Efficacy


In some cases, surgery can offer an effective means of eliminating or correcting the principal cause of secondary hypertension. Surgical measures include removal of thyroid gland tissue, excision of a pheochromocytoma (a tumor that produces adrenaline-like hormones that can cause very high blood pressure), or repair of damaged blood vessels (angioplasty).

Appropriate Healthcare Setting

Inpatient care is only necessary for people who need surgery to correct a case of secondary hypertension or for people who experience a hypertensive emergency.

Activity & Diet Recommendations

Any exercise that is aerobic can be helpful in lowering your blood pressure. These include walking, swimming, bicycling. Avoid isometric exercises such as bodybuilding, weight lifting, or push-ups. These raise blood pressure. Never start an exercise regime without first consulting your physician.

Relaxation exercises can be helpful in reducing hypertension. These activities may include mediation, reading, painting, and gardening. Some people benefit from biofeedback programs. Anything that can reduce the stress in your daily life is worthwhile.

Reducing your intake of sodium is also important. Here is some general information related to reducing sodium in your diet:

  • Table salt is about 40% sodium — and the main culprit
  • Americans consume 20 times more salt than their bodies need — 2,000 mg is the average daily recommended amount
  • About 75% of your salt needs are already in the foods you eat and drink
  • The recommended amount of salt for people with hypertension is the equivalent of just one teaspoon a day — You can easily reach this without adding any more salt to your food.
  • For some people who are especially sensitive to the sodium, even a moderate amount of salt can raise their blood pressure.

Avoid salty foods and snacks such as bacon, sausage, pretzels, potato chips, mustard, olives, pickles, and some cheeses. (Obviously, picnics can be hazardous to your low-salt diet.) Buy more fresh meats, fruits, and vegetables instead of canned, frozen, or processed ones. Avoid fast foods or convenience foods.

Be aware of hidden sodium — foods and beverages that contain salt you might not have considered. These include many carbonated drinks, nondairy creamers, cookies, and cakes.

Get to know what's in the foods you buy and eat. Learn to read the labels on all processed and packaged foods. Sodium levels are printed on the back, along with other nutritional information. Many over-the-counter medicines also contain high levels of sodium, such as alkalizers for stomach indigestion, aspirin, cough medicine, mouthwash, and even toothpaste.

If your doctor prescribed a diuretic (water pill) to help control your blood pressure, you may need to add potassium to your diet because some of these medications lower potassium levels. Foods low in sodium and high in potassium include chicken and turkey, veal, many type of fish (halibut, fresh sardines, scallops), fruits (bananas, plums, raisins, nectarines), fresh vegetables (carrots, lima beans, potatoes, and spinach), orange juice, unsalted peanuts and peanut butter, and dry milk.

Monitoring the Condition

The best means of controlling hypertension is through monitoring your own blood pressure on a regular basis and periodic visits to your doctor for evaluation of your progress, adjustment to medication, and status of target organs (at-risk organs such as your heart, brain, kidney, and eyes). Once your condition stabilizes, your status should be monitored at least once every three to six months. A yearly urine sample analysis and an assessment of your creatine and potassium levels are generally appropriate as part of a healthy follow-up plan.

Possible Complications

Unchecked, sustained hypertension causes damage to your blood vessels, which leads to a reduction in blood flow. This, in turn, can lead to widespread organ damage, especially to your heart, brain, kidney, and eyes. Untreated hypertension may eventually cause the formation of aneurysms in various parts of the body, especially the brain (which can cause brain hemorrhage), eyes (which can cause blindness), and aorta (a large blood vessel emanating from the heart, the rupture of which could result in death). Cardiac damage results in heart attack, heart failure, and thickening of the muscles of the heart (hypertrophy), which may be fatal.

Hypertension is the number one cause of strokes. Strokes themselves could be caused by the plugging of the arteries to the brain due to increased fatty deposits, blood clot formation, and blood clots coming from distal arteries supplying the brain.

Hypertension also causes kidney damage and eventually kidney failure.

Abruptly discontinuing your medication without your doctor's approval can result in rebound high blood pressure that could possibly precipitate a condition called hypertensive crisis. This is a rare but life-threatening complication where blood pressure can rise sharply to 200/120 and beyond. A hypertensive emergency exists if this sudden rise in blood pressure is also accompanied by acute target-organ injury as characterized by one or more of the following conditions:

  • Encephalopathy
  • Intracranial hemorrhage
  • Left ventricular failure accompanied with fluid buildup in the lungs (pulmonary edema)
  • Abnormal dilation of the aortic wall (aortic aneurysm)
  • Eclampsia
  • Spasmodic attacks of suffocating pain (unstable angina)

Quality of Life

All drugs prescribed to treat hypertension have side effects. Be sure to ask your doctor which drugs have the least problematic side effects for you.

Considerations for Women

Hypertension affects more women as people age. Women over age 65 especially need to have their blood pressure checked regularly.

Oral contraceptives are the most frequent reversible cause of secondary high blood pressure. If you are on birth control pills, you are two to six times more likely to suffer from high blood pressure. If your OB/GYN recommends discontinuing oral contraception, your blood pressure will probably return to normal within three months.

Hypertension also can occur in a small number of postmenopausal women taking estrogen replacement therapy. If you fall into this category, have your doctor check your blood pressure regularly.


Approximately 2% of pregnant women have chronic hypertension. Often this is of a mild form (140/90 to 150/100), and is not of great concern. If you are planning on becoming pregnant, or already are, consult your family doctor or obstetrician the possible need for a blood-pressure-lowering drug that will not harm your fetus.

About 5% of first-time pregnant women who have preexisting hypertension are at increased risk of developing a condition known as preeclampsia. This may occur between the 20th week of pregnancy and week after delivery of the baby. Preeclampsia is accompanied by a 30 mm increase in systolic pressure or 15 mm in diastolic pressure. There may also be swelling in the face or hands and the presence of albumin (protein) in the urine. Preeclampsia is a very serious condition that may threaten the health of both the mother and the fetus, and force a premature birth. Your physician may prescribe a drug that is safe for pregnant women.

Nursing mothers

If you are breastfeeding your baby and know you have high blood pressure, consult with your doctor regarding which therapies are safe — or if you should discontinue nursing while taking any medications.

Considerations for Older People

Older people with hypertension need to be especially careful with when taking any drugs for their condition. As with any medications, be sure to let your doctor or pharmacist know which additional drugs you may already be taking to prevent any adverse reactions from inappropriately combined drugs. Isolated systolic hypertension (above 160/85 to 160/90) is usually found in older people.


Last updated 25 May 2012


  • Arterial hypertension
  • Essential hypertension
  • Primary hypertension
  • Secondary hypertension


Established Causes

Medical practitioners classify hypertension into two categories:

  • Primary hypertension: accounts for 90% to 95% of cases. The underlying cause is indeterminable.
  • Secondary hypertension: can be directly linked to an underlying disease (especially kidney disease), hormonal disorders, and certain drugs (such as oral contraceptives, alcohol, and corticosteriods).

Risk Factors

Hypertension has no known cause in over 90% of cases, although it has been established that high blood pressure tends to run in families. If one of your parents had it, you may be at risk, so it's helpful to know their medical history.

Also, diet, lifestyle and your overall health may play a role. Among the possible risk factors within your control are the following:

  • Obesity
  • Alcohol consumption
  • Excess sodium (salt) in your diet
  • Stress
  • Physical inactivity
  • Smoking
  • Taking some types of over-the-counter medications including antacids, laxatives, diet pills, and nonprescription cold, sinus and allergy remedies that contain ingredients such as ephedrine, pseudoephedrine, and sodium

Other risk factors include the following:

  • Kidney disease
  • Gout
  • Diabetes mellitus

Symptoms & Diagnosis

Hypertension has no symptoms. Without a blood pressure test you cannot be sure if you have high blood pressure. Signs and symptoms that do show up are usually associated with the secondary conditions caused or worsened by high blood pressure. If you have any of these symptoms, see your doctor:

  • Frequent headache
  • Recurring dizzy spells
  • Any unusual changes in your vision
  • Chest pains, with or without exertion
  • Cramps in your legs when walking
  • Swelling in your ankles or feet
  • Difficulty thinking or loss of concentration

Conditions That May Be Mistaken for Primary Hypertension

A diagnosis of primary hypertension may be eliminated if it is discovered that at least one of the following disorders are contributing to abnormally elevated blood pressure levels:

  • Chronic kidney disorders
  • Constriction of at least one major renal artery
  • Hormonal disorders such as Cushing's disease, hyperaldosteronism, and pheochromocytoma

How Is Hypertension Is Diagnosed

Diagnosis of hypertension should never be made on the basis of a single reading. Usually three blood pressure measurements over the course of about a week are sufficient for diagnosis. If your blood pressure fluctuates irregularly, your doctor may want you to wear a portable monitor that periodically takes blood pressure readings.

Laboratory Work

Laboratory tests are available to search for the cause of secondary hypertension.

Specific Tests

Your doctor may administer an ophthalmoscopic examination in order to evaluate possible vascular damage in the retina. A chest X-ray, electrocardiogram (EKG), or echocardiogram may be required to confirm possible hypertension-related complications such as an enlarged heart or weakened heart or presence of scarring due to an old heart attack.


Sonograms, radioactive tracer scans, and computed tomography (CT) scans are useful in delineating kidney damage and detecting abnormal dilatation (aneurysm) of the major arteries. Magnetic resonance (MR) angiograms and cerebral arteriograms are useful in detecting and evaluating cerebral aneurysm.

Alternative care

Current Therapies Available

While alternative therapies cannot necessarily provide a cure for hypertension, they can reduce or in some cases eliminate your dependence on medication. The following alternative therapies may be useful:

  • Acupuncture
  • Biofeedback
  • Exercise conditioning
  • Herbal medicine
  • Homeopathy
  • Nutritional therapy
  • Yoga and meditation


  • Calcium: Researchers at McMaster University in Hamilton, Ontario, analyzed 33 studies in which supplemental calcium helped lower blood pressure. Most experts recommend 1,000 to 1,500 mg/day.
  • Potassium: Diuretic blood-pressure medication depletes potassium. Experts advise supplementation of up to 300 mg/day.
  • Fish oil: You don't have to eat salmon to get omega-3 fatty acids. Fish-oil supplements provide the same benefits. Most experts recommend 4 g/day.


  • Practice meditation. Meditation and similar relaxation techniques produce states of deep relaxation, which dilates the blood vessels. And as blood vessels dilate, blood pressure falls. Several studies show that meditation and other deep relaxation programs — for example, biofeedback — successfully treat hypertension. In one study, 111 hypertensive African-Americans either took a class on lifestyle modifications for blood pressure control or learned to meditate. The lifestyle class had no effect, but the meditators' blood pressures dropped significantly.
  • Care for a pet. Do you enjoy romping with a dog? Or having a cat purr on your lap? Many studies show that caring for a pet is relaxing enough to offer a modest reduction in blood pressure.

Self care & Prevention

Reducing High Blood Pressure

  • Don't smoke. It constricts blood vessels, which in turn raises blood pressure.
  • If you are overweight, try to lose some pounds. Extra weight means your heart has to pump harder to circulate blood through all that extra tissue, thereby raising your blood pressure. Weight loss is a cornerstone of blood pressure treatment, with many studies showing that a loss of 10 to 20 pounds can lower blood pressure significantly.
  • Get regular exercise. This is another key element of weight loss that also reduces stress, which often contributes to hypertension. Several studies show that a daily brisk walk for 30 minutes helps reduce blood pressure.
  • Monitor your blood pressure. If your doctor has diagnosed you with hypertension, or even if you just think you may be at risk for developing hypertension, you should have your blood pressure checked regularly. Your goal should be to maintain a level below 140/90. You can also check your own blood pressure with a home blood pressure monitor. These can help you easily monitor how well you are controlling your hypertension in between doctor's office visits.
  • Know your family history. The vast majority of hypertension cases may be related to heredity. If you have a close family member who has high blood pressure, you may be at risk, too. Be sure to let your doctor know so that he or she can detect hypertension early and help you start an program of prevention.
  • Reduce stress. Stress often leads to increased blood pressure.
  • Follow your doctor's orders. Full compliance with the antihypertensive program designed by your physician is important. This includes exercise, diet, and taking your medications as prescribed.

Your Diet

  • Don't abuse alcohol. A moderate amount — up to two drinks a day for men and one for women — can actually reduce the risk of heart attack. But any more usually raises blood pressure (and heart attack risk). Heavy drinking is a major cause of hypertension.
  • Switch to decaf. Caffeine is a powerful stimulant that can raise blood pressure. Tea, cocoa, chocolate, and many over-the-counter drugs contain caffeine.
  • Become a vegetarian — or close to it. Several studies have shown that vegetarianism lowers blood pressure.

    The most compelling was the Dietary Approaches to Stop Hypertension (DASH) study conducted by Harvard researchers. They placed 459 people with moderately high pressure on one of three diets:

    • A typical American meat-centered, high-fat diet with little fiber and few fruits or vegetables
    • A meat-based, high-fat diet with more fiber, fruits, and vegetables
    • A near-vegetarian, low-fat diet loaded with fruits, vegetables, and whole grains, including fish and some chicken
  • Participants on the meaty, high-fat diets recorded no drop in blood pressure. But in just eight weeks, participants on the near-vegetarian, low-fat diet reduced blood pressure significantly — about as much as people taking prescription blood pressure medications. Fruits, vegetables, and whole grains are all high in fiber, vitamin C, and potassium, which help reduce blood pressure.

  • Reduce your salt intake. As salt consumption rises, the body retains excess water, which raises blood pressure. The Trials of Hypertension Prevention (TOHP) at Tulane University have shown that salt restrictions consistently reduce blood pressure. Because of these studies — and many others — the National High Blood Pressure Education Program recommends that Americans limit their sodium intake to control their blood pressure.
  • Consume more calcium. It has a number of effects on the blood vessels. More than 50 studies show that as dietary calcium rises, blood pressure falls. High-calcium foods include dairy items, salmon, leafy vegetables, and tofu.
  • Eat more salmon. In addition to calcium, salmon contains a generous helping of omega-3 fatty acids, which reduce blood pressure, according to a review of more than 20 studies by a researcher at Vanderbilt University in Nashville, who suggests eating salmon once or twice a week.