GoodRx Guide
High Blood Pressure (Hypertension)
Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
Definition
High blood pressure, also called hypertension, is when the force of the blood pushing against the artery walls is too high. High blood pressure is a very common problem in the U.S.; the American Heart Association estimates that more than 100 million American adults have the condition. Hypertension is called the “silent killer,” because many people are not aware that they have it.
If left untreated, high blood pressure can lead to:
Heart disease
Eye damage
Death
Talk to your healthcare professionals about your blood pressure readings. This is especially important if you have a family history of high blood pressure, or if you’ve got other health problems like diabetes that put you at higher risk of heart disease and other cardiovascular problems.
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Causes
For most people with the condition, their high blood pressure is considered “primary” or “essential.” This means it’s not a direct result of another condition. Primary hypertension is caused by a combination of genetic factors and lifestyle habits.
You are much more likely to get high blood pressure if you:
Have a relative with high blood pressure
Are older
Have overweight or obesity
Don’t get enough physical activity
Consume a high-sodium diet
Drink more alcohol than is recommended
“Secondary” hypertension is high blood pressure that’s caused by another medical condition or medication, such as:
Many prescription and over-the-counter medications
Recreational drugs like cocaine and amphetamines
Kidney disease
Narrowing of the large blood vessel that carries blood from the heart (coarctation of the aorta)
Hormonal conditions like over- or underactive thyroid, Cushing’s syndrome, high aldosterone, or pheochromocytoma
Symptoms
The majority of people with high blood pressure do not have symptoms, even when their blood pressure reaches dangerously high levels. When people have symptoms with high blood pressure, they report:
Headaches
Changes to their vision
Flushing
Chest pain
Shortness of breath
Related Health Conditions
Diagnosis
Blood pressure is measured using an inflatable arm cuff. A blood pressure reading consists of a systolic blood pressure (top number) and diastolic blood pressure (bottom number). High blood pressure is diagnosed when the systolic and diastolic pressures are elevated on several occasions.
The current definitions for “normal” and “high” levels of blood pressure are:
Normal blood pressure (considered healthy)
Top number less than 120 mmHg
And bottom number less than 80 mmHg
Elevated blood pressure (needs close monitoring)
Top number 120 mmHg to 129 mmHg
And bottom number less than 80 mmHg
Hypertension or high blood pressure (needs treatment)
Top number above 130 mmHg
Or bottom number above 80 mmHg
You should have your blood pressure measured at least once per year if you don’t have risk factors for high blood pressure. If you do have risk factors, your blood pressure should be measured at least every 6 months, and more often if your blood pressure is elevated. For some people, it can be helpful to have a blood pressure cuff at home so they can measure and monitor their own blood pressure.
Lifestyle changes
If you have been diagnosed with high blood pressure, no matter how mild or severe, your provider will prescribe lifestyle changes as part of your treatment program. These include:
Restricting the amount of salt (sodium) you eat
Weight loss, or maintaining a healthy weight
Quitting smoking
Reducing alcohol intake
Medications
The decision to start medication for the treatment of blood pressure is based on how high the blood pressure is and the person’s individual health and circumstances. Sometimes, two or more medications are needed to lower the blood pressure to safe levels. You should plan to work closely with your physician to find the right treatment plan for you.
These are four classes of blood pressure medications that are considered “first line,” or the most effective medicines used to lower blood pressure.
Thiazide diuretic or thiazide-type diuretic
Thiazide diuretics are a type of “water pill,” which helps your kidneys eliminate excess sodium and fluid from the body. These medications are commonly used in combination with other medications for control of high blood pressure. Some examples are:
Angiotensin-converting enzyme inhibitor
Angiotensin-converting enzyme (ACE) inhibitors block the production of a hormone called angiotensin II, which the body uses to control blood pressure. They are commonly used to protect the kidneys in people with kidney disease and diabetes, and are also used in people with heart failure. Some examples are:
Angiotensin receptor blocker
Angiotensin receptor blockers (ARBs) also block angiotensin II. They are similar to ACE inhibitors, and are used in people with similar medical conditions, but are sometimes more effective at lowering blood pressure. Some examples are:
In addition, GoodRx has partnered to make some comparable, brand-only drugs more affordable, such as the ARB Edarbi (azilsartan) and the ARB/thiazide diuretic combination drug Edarbyclor (azilsartan/chlorthalidone).
Calcium channel blocker
Calcium channel blockers prevent calcium from entering muscle cells found in blood vessels, causing them to relax. In some cases, they can also slow the heart rate, which can be useful in conditions such as atrial fibrillation. Examples are:
There are several other classes of medications that can lower blood pressure, and can be used alone and in combination with the medications listed above. These include:
Alpha blockers: doxazosin
Alpha-beta blockers: carvedilol, labetalol
Beta blockers: metoprolol, atenolol
Aldosterone antagonists: aldactone
Renin inhibitors: aliskiren
Vasodilators: hydralazine, minoxidil
Central-acting agents: clonidine
If you take medications for high blood pressure, and have side effects from the medications, please contact your health care provider promptly. Never stop your medications suddenly without consulting a medical professional.
Prevention
The best way to prevent high blood pressure is to make healthy lifestyle changes. These include:
Not smoking or vaping
Avoiding excessive alcohol and caffeine
Maintaining a healthy weight
Common concerns
A reading of 110/70 would be considered a normal blood pressure. A reading of 138/80 would be considered mild hypertension.
A top number of 120 to 129 and a bottom number of less than 80 is considered elevated blood pressure.
A top number of 130 to 139 or a bottom number of 80 to 89 is stage 1 hypertension.
A blood pressure reading above 140/90 is stage 2 hypertension.
A reading of 180/120 or higher is considered a hypertensive crisis and requires emergency medical attention.
In some cases. There are two main types of high blood pressure: Primary (or “essential”) hypertension and secondary hypertension. Unfortunately, there is no cure yet for primary hypertension. However, healthy lifestyle habits can help keep your blood pressure under control, and may be able to reduce the amount of medications that you need to take. Secondary hypertension is high blood pressure caused by another health condition. In some cases, treating the underlying condition causing the high blood pressure can “cure” the high blood pressure, but this is not always possible.
This is a topic of debate. A recent Korean study showed that in a large group of over 35,000 participants, people with a history of elevated blood pressure had an increased risk of nosebleeds requiring hospital visits compared with people with no history of high blood pressure. However, the general thinking is that nosebleeds do not result from high blood pressure unless the blood pressure is extremely high, like in a hypertensive crisis.
References
American Addiction Centers. (2020). How much alcohol is safe to drink daily?
American Heart Association. (2016). How high blood pressure can lead to kidney damage or failure.
American Heart Association. (2016). Shaking the salt habit to lower high blood pressure.
American Heart Association. (2017). Know your risk factors for high blood pressure.
American Heart Association. (2017). Types of blood pressure medications.
American Heart Association. (2018). American Heart Association recommendations for physical activity in adults and kids.
American Heart Association. (2018). More than 100 million Americans have high blood pressure, AHA says.
American Heart Association. (2018). Steps for accurate BP measurement.
American Heart Association. (2020). What you need to know about how sleep apnea affects your heart.
American Heart Association. (2021). Atrial fibrillation.
American Heart Association. (2021). Changes you can make to manage high blood pressure.
American Heart Association. (2021). Coarctation of the aorta (CoA).
American Heart Association. (2021). Effects of excess sodium infographic.
American Heart Association. (2021). Hypertensive crisis: When you should call 911 for high blood pressure.
American Heart Association. (2021). Reducing stress.
American Heart Association. (2021). Stroke warning signs.
Centers for Disease Control and Prevention. (2021). What is blood pressure?
Whelton, P.K., et al. (2017). ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American heart association task force on clinical practice guidelines. Hypertension.
