High blood pressure
High blood pressure usually has no symptoms, but over the years it strains the heart, brain and kidneys. Here you can read which numbers count as high, how to measure correctly, and why it should be looked at together with blood sugar and blood fats.
What is high blood pressure?
Blood pressure is the force the blood puts on the walls of the vessels as it circulates. If this force stays too high for a long time, it is called high blood pressure, or hypertension. Each measurement has two numbers. The first, higher number is the pressure when the heart contracts, and the second is the pressure between beats, when the heart relaxes.
Untreated high blood pressure keeps straining the vessels, heart, brain, kidneys and eyes, and raises the risk of heart attack, stroke, heart failure, kidney disease and dementia. The good news is that even a small reduction in blood pressure lowers this risk.
Symptoms
Most people have no symptoms and do not find out until they are measured. Sometimes there is a headache, blurred vision or chest pain, but having no symptoms does not mean you are healthy. The only reliable way is to measure. If you are 40 or older and have not had your blood pressure checked for more than 5 years, it is time to have it measured.
High blood pressure and the rest of the body
High blood pressure is not just a number. It is part of a bigger picture:
- Blood sugar: Diabetes is one of the conditions that raises the risk of high blood pressure. High blood sugar also damages the vessels, so in someone who has both, the vessels are under two kinds of strain.
- Blood fats: Lowering blood pressure alone is not enough to prevent heart attack and stroke. Looking after blood sugar, blood pressure and blood fats together lowers the risk of heart disease and stroke.
- Weight and activity: Excess weight, inactivity and a high-salt diet are risk factors for high blood pressure, and excess weight is also seen alongside diabetes. So looking after weight and activity helps with all three.
- Kidneys: High blood pressure is an important cause of chronic kidney disease. That is why the doctor sometimes asks for a kidney test too.
For this reason it is best to follow blood pressure, blood sugar and blood fats together, with one doctor.
What counts as high blood pressure?
Sources do not give a single number, and it is better to know about this difference:
- British guideline: 140 over 90 or higher in the clinic, and 135 over 85 or higher at home, counts as high.
- American guideline: A sustained pressure of 130 over 80 or higher is high. Stage 1 is 130 to 139 or 80 to 89, and stage 2 is 140 or 90 and above. Below 120 over 80 is normal, and 120 to 129 with a lower number under 80 is called “elevated”.
The treatment target is set by the doctor for each patient and depends on age, diabetes, kidney disease and other conditions. Do not make a number you read somewhere your own target.
How is it diagnosed?
Diagnosis is by measuring blood pressure. Because the number rises and falls during the day, the doctor may measure several times and at more than one visit, or ask for home monitoring with a validated device. The measurement is done with a cuff around the upper arm, takes a few minutes, and is sometimes repeated to be sure.
If you are going to measure at home, you usually measure once, write the number down, wait a minute, and measure again. This is usually done in the morning and evening, for as many days as the doctor has said. Sometimes you are also given a portable 24-hour monitor, which you wear and return the next day.
Treatment and management
The foundation is a change in lifestyle, and many patients also need medicine:
- Food: Less salt, more vegetables, fruit and whole grains, low-fat dairy, and less fatty meat, sweets and sugary drinks. The DASH eating pattern, designed for high blood pressure, is exactly this. In it the ceiling for sodium is 2,300 mg a day, and 1,500 mg lowers blood pressure even further. If you have kidney or heart disease, check the right amount with your doctor.
- Activity: About 30 minutes a day, 5 days a week, or at least 150 minutes a week. It is best to start at your own pace and build up gradually.
- Weight and tobacco: Reach a healthy weight, avoid cigarettes and other tobacco, and cut down on too much caffeine.
- Stress: Long-term stress is a risk factor for high blood pressure, and managing it is part of care.
- Medicine: If blood pressure is very high, the risk of heart attack or stroke is high, or it does not come down with lifestyle changes, the doctor prescribes medicine. The type depends on your blood pressure, age and conditions, and some patients need more than one medicine. Do not start, stop or change your blood pressure tablets yourself, even if your numbers have become normal.
Follow-up and self-care
- Measure your blood pressure according to your doctor’s plan, and write the numbers down with the date and time.
- Tell your doctor about every other medicine, supplement and herbal remedy you take.
- Have your blood sugar, blood fat and kidney tests on time, because they are linked to high blood pressure.
- If you are pregnant or planning a pregnancy, let your doctor know.
- Use a validated device to measure at home, and ask your doctor which type suits you.
When to get help
Call 115 (Iran’s emergency number) immediately if you have sudden pain or pressure in the chest that does not go away. The pain may be pressing, heavy or burning, and may even feel like indigestion. The risk is higher if the pain spreads to the arm, neck, jaw, abdomen or back, or comes with sweating, nausea, light-headedness or shortness of breath. Sudden weakness or numbness, a change in vision and trouble speaking are also emergencies. Do not drive yourself.
If your blood pressure is above 180 and/or 120 and you have any of these symptoms, it is an emergency, so call 115. If you have the same numbers but no symptoms, contact your doctor.
Frequent headaches, blurred vision, blood pressure that stays high despite treatment, or dizziness and weakness after starting a medicine are reasons to see your doctor.
Every patient’s treatment plan is different. Ask your doctor about your own situation.
Frequently asked questions
My blood pressure is high but I have no symptoms. Do I still need follow-up?
Yes. High blood pressure usually has no symptoms and is only revealed by measuring it. If it is not treated, it damages the heart, brain, kidneys and eyes over the years. Whether you need treatment, and what kind, is decided by the doctor after several measurements and a review of your overall health.
What is a normal blood pressure?
Not all guidelines use the same limit. One guideline counts 140 over 90 or higher as high in the clinic and 135 over 85 or higher at home. The American guideline counts 130 over 80 and above as high. The right target for you depends on your age, diabetes, kidney disease and other conditions, and your doctor will set it.
If my blood pressure becomes normal, can I stop the tablets?
Not on your own. A normal reading is often the result of that very treatment. Stopping a medicine or changing its amount should be decided only by the doctor, based on your measurements.
Why is my blood pressure higher in the clinic than at home?
Blood pressure changes during the day and may be higher in the clinic. That is why the doctor sometimes asks for several days of home measurements or a 24-hour monitor. Write down your home readings and bring them with you.
What does high blood pressure have to do with blood sugar and blood fats?
High blood pressure, high blood sugar and high blood fats each damage the blood vessels, and when they occur together the heart and vessels come under even more strain. Diabetes is one of the things that raises the risk of high blood pressure. That is why it makes sense to check all three together.