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High blood pressure

High blood pressure

At a glance

  • High blood pressure is not something you can feel.
  • Long-term high blood pressure increases the risk of vascular disease and problems, such as strokes.
  • It can also cause damage to your heart or kidneys.
  • There is a lot you can do on your own to keep your blood pressure within normal range: getting enough exercise, eating less salt and losing some weight (if you’re overweight).
  • You can also use medication to lower your blood pressure.

Introduction

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Many people have high blood pressure (hypertension). But they usually don’t notice it – it can only be detected by measuring the blood pressure.

If the blood pressure is high over a longer period of time, it strains the blood vessels. That can increase the risk of a or stroke and damage the heart and kidneys. Generally speaking, the higher your blood pressure, the greater your risk of developing these medical conditions.

Sometimes, a change in lifestyle is enough to lower blood pressure. But medications that can lower blood pressure (antihypertensives) are also available.

Symptoms

High blood pressure itself usually goes unnoticed. Only if it is extremely high can it sometimes cause symptoms like dizziness or trouble seeing. If that happens, it may be a medical emergency.

But blood pressure that remains high for years at a time can result in other conditions that cause noticeable symptoms. For instance, heart failure can lead to shortness of breath and fluid retention in the legs. Heart rhythm disorders (arrhythmias) can cause a rapid heart rate (palpitations). Coronary artery disease (the hardening of the important arteries near the heart) can cause noticeable chest pain during physical activity (like climbing stairs).

Causes

The heart supplies the organs and tissues of the body with blood. With every beat, it pumps blood into the bloodstream. When this happens, the blood pushes against the walls of the blood vessels, which is our blood pressure.

Our bodies are able to regulate blood pressure as needed. Your blood pressure is typically at its lowest point when you are relaxing or sleeping. It increases when we do hard physical work and our muscles need more blood. Stress or fear can also cause your blood pressure to go up. It usually naturally increases a bit with age in most people as well.

So it’s normal for blood pressure readings to vary; that's just a sign of an active life. But the blood pressure levels in many people are constantly too high. Often, no exact cause is found. Then doctors call it “essential” or “primary” hypertension.

A cause of the high blood pressure is found in about 5 out of 100 people who have it. Possible causes include an overactive thyroid gland (hyperthyroidism) or a narrowed kidney artery. When the cause is known, doctors refer to it as “secondary” hypertension.

Sometimes medications can also increase blood pressure somewhat. Those medications include the following:

  • Some medicines used to treat psychological illnesses
  • Anti-inflammatory painkillers like diclofenac or ibuprofen
  • Decongestant nasal sprays or drops
  • Hormonal contraceptives that contain estrogens, like many birth control pills

Risk factors

Your lifestyle has a lot to do with how high your blood pressure is. The most important risk factors for high blood pressure include:

But slim, athletic people who watch what they eat can also develop high blood pressure – for example, because it runs in their family.

Environmental factors like air pollution from vehicle traffic can increase blood pressure, too.

Prevalence

In Germany, about 50% of men and 40% of women have high blood pressure. These numbers increase with age. About 15% of adults with high blood pressure don't know that they have it.

Effects

Long-term high blood pressure increases the risk of cardiovascular disease and can cause damage to various organs. Constant high levels of pressure in the arteries causes them to become stiffer. As a result, the heart always has to work harder to pump enough blood around your body.

The possible long-term effects of high blood pressure include the following:

But high blood pressure is only one of many risk factors for these kinds of complications. Other factors include family history, poor , diabetes, being overweight and smoking. The risk increases more with age.

Taking all of the factors together, it’s possible to statistically estimate how likely different complications are for an individual person. Family doctors can use a risk calculator to help find the specific risk.

The risk of complications can be lowered by changing your lifestyle and taking antihypertensives.

Diagnosis

There are a number of different devices that can more blood pressure either at the doctor's or at home. Your blood pressure varies naturally, so it is measured on several days to get a more reliable result than a single reading can offer.

Good to know:

Regardless of whether you take your blood pressure at home or at the doctor’s, the measurements need to be done carefully and more than once.

Blood pressure is measured in units of “millimeters of mercury,” (mmHg). Blood pressure readings have two values that are always listed together: 128/85 mmHg, for example. The first number represents the pressure in the blood vessels when the heart muscles squeeze (systolic blood pressure). The second represents the pressure in the blood vessels when the heart muscles relax (diastolic blood pressure).

An adult’s blood pressure is considered to be normal if it is less than 140 over 90 (140/90). High blood pressure is diagnosed if

  • the systolic reading is greater than 140 mmHg,
  • the diastolic reading is greater than 90 mmHg, or
  • both readings are greater than these values.

If your doctor measures one high blood pressure reading, then your blood pressure is measured again to confirm the . Measuring blood pressure over a 24-hour period (ambulatory blood pressure monitoring) is usually recommended because that gives you the most reliable results. That involves carrying a portable instrument with you that measures your blood pressure with a cuff. Alternatively, you can measure your blood pressure at home several times or have it checked again at the doctor's four weeks later.

To detect any complications or other problems that might be related to the high blood pressure, your doctor will also ask about the following:

  • Problems like palpitations, shortness of breath or chest pain, and erection problems in men
  • Physical abnormalities like an elevated pulse, fluid retention, nervous disorders or unexpected changes in weight
  • Other health conditions that you or your close family have
  • Any medications that you use
  • Your lifestyle, for instance whether you smoke
  • For women: whether you are pregnant

Blood and urine testing can be used to check how your kidneys are functioning, among other things. An ECG can show whether you might have a heart rhythm problem.

Which other tests might be helpful will depend on your age and your individual risk factors.

Treatment

There are a number of things you can do on your own to lower high blood pressure. Some people manage to keep their blood pressure under control by doing the following:

    You can also use medication to lower your blood pressure – either in addition to these things or instead. That is an option if you can’t or don’t want to change your lifestyle, or if that doesn't make enough of a difference.

    Learn more

    Lowering your blood pressure by changing your lifestyle
    What medications are used to treat high blood pressure?
    When is taking medication for high blood pressure a good idea?
    Tips for reducing your salt intake

    Deciding

    What you want to do about high blood pressure is a personal decision. High blood pressure that is just a little too high can often be lowered to a normal level just by changing your lifestyle. Medication is usually needed for very high blood pressure. Medications have side effects, though – and their benefits are not the same for everyone. That depends on your individual risk of complications.

    High blood pressure: How can you lower it?

    When deciding whether or not to use medication, it’s a good idea to find out about the pros and cons first.

    Further information

    When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

    Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie Hypertonie. AWMF-Registernr.: nvl-009. 2023.

    Schikowski T, Wigmann C, Fuks KB et al. Blutdruckmessung in der NAKO – methodische Unterschiede, Blutdruckverteilung und Bekanntheit der Hypertonie im Vergleich zu anderen bevölkerungsbezogenen Studien in Deutschland [Blood pressure measurement in the NAKO German National Cohort (GNC) – differences in methods, distribution of blood pressure values, and awareness of hypertension compared to other population-based studies in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63(4): 452-464.

    Young MT, Jansen K, Cosselman KE et al. Blood Pressure Effect of Traffic-Related Air Pollution: A Crossover Trial of In-Vehicle Filtration. Ann Intern Med 2023; 176(12): 1586-1594.

    IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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    High blood pressure

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    Updated on June 26, 2024

    Next planned update: 2027

    Publisher:

    Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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