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High Blood Pressure: What Cardiologists Insist You Know

In this video, learn how doctors diagnose and treat high blood pressure to prevent further damage to the heart and body.

Lauren SmithMera Goodman, MD
Written by Lauren Smith | Reviewed by Mera Goodman, MD
Updated on January 9, 2021

Measuring blood pressure may seem like a routine part of your doctor’s visit, but understanding its role in your heart health is critical. If left untreated, high blood pressure can have serious consequences on the rest of the body, including stroke, heart failure, vision loss, erectile dysfunction in men, decreased sex drive in women, and kidney disease.

Unfortunately, high blood pressure doesn’t typically present symptoms at first, according to Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. “That’s the reason why we call it the ‘silent killer,’” says Dr. Bloom. In many cases, by the time high blood pressure is detected, a lot of damage—sometimes fatal—has already been done.

Your heart is like the engine for the rest of the body, pumping blood throughout the body and delivering oxygen to cells and organs. If your heart can’t do its job well, the rest of the body has to work extra hard to function with less oxygen.

“Blood pressure is simply a physical measurement of the tension or pressure of the blood in the arteries,” says Paul Knoepflmacher, MD, a clinical instructor in medicine at The Mount Sinai Hospital. The top number represents the pressure when your heart contracts (the systolic pressure), and the bottom shows the pressure when it relaxes (diastolic pressure).

Blood pressure readings fall into one of four categories, according to Dr. Knoepflmacher.

  • Normal blood pressure is less than 120 (systolic) over less than 80 (diastolic).

  • Elevated blood pressure is between 120 and 129 (systolic) over less than 80 (diastolic).

  • Hypertension stage 1 is between 130 and 139 (systolic) over 80 to 89 (diastolic).

  • Hypertension stage 2 is 140 or greater (systolic) over 90 or greater (diastolic).

In early stages of treatment for high blood pressure, medication may not be necessary. “I give [patients] either a few weeks or a few months to see if they can bring down their blood pressure naturally,” says Dr. Bloom.

Experts recommend a few key lifestyle changes for lowering blood pressure.

  • Exercise. Cardio exercises, such as running or biking, are your “first line of defense” against high blood pressure, says Joan Pagano, an exercise physiologist in New York City.

  • Limiting caffeine, alcohol, and sodium. “Sodium has a direct relationship with high blood pressure,” says Antonella Apicella, RDN, a dietitian with the Lenox Hill Hospital Outpatient Nutrition Program. “Limiting to 1,500 mg for the day is very effective in lowering that blood pressure.” (Here are ways to eat less salt for a healthier heart.)

  • Eating a heart-healthy diet. One simple way to improve your diet is including more color, suggests Frances Largeman-Roth, RDN, a nutritionist in New York City. Adding more colorful fruits and veggies can help nourish your body with crucial micronutrients, including potassium. A potassium-rich diet can counteract some of sodium’s negative effects on the body. (Here are the best food sources of potassium to add to your diet.) Learn more about the diet recommended to lower high blood pressure here.

If medication for blood pressure is needed, the most common choices are diuretics, angiotension II receptors, ACE inhibitors, calcium channel blockers, beta blockers, alpha agonists, or vasodiolators.

“Once you start a medication [for blood pressure], it doesn’t necessarily mean you’re going to be on that for the rest of you life,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital. The deciding factor? Committing to lifestyle changes. Here are smart lifestyle tweaks for a healthier heart.

Additional Medical Contributors (6)
  • Michelle Weisfelner Bloom, MDDr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.
    • Paul Knoepflmacher, MDDr. Knoepflmacher is a clinical instructor of medicine at The Mount Sinai Hospital in New York City, where he also maintains a private practice.
      • Joan PaganoJoan Pagano is an exercise physiologist in New York City.
        • Antonella ApicellaAntonella Apicella is a registered dietitian at the Lenox Hill Hospital Outpatient Nutrition Program.
          • Rachel Bond, MDDr. Bond is a cardiologist and associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and an assistant professor of cardiology at Hofstra Northwell School of Medicine.
            • Frances Largeman-Roth, RDNFrances Largeman-Roth is a nutritionist and cookbook author in New York City.

              References

              Get The Facts: Sodium and the Dietary Guidelines. Atlanta, GA. CDC (Accessed on January 8, 2021 at https://www.cdc.gov/salt/pdfs/sodium_dietary_guidelines.pdf)

              Changes you can make to manage high blood pressure. Dallas, TX: American Heart Association. (Accessed on January 9. 2021 at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/MakeChangesThatMatter/Changes-You-Can-Make-to-Manage-High-Blood-Pressure_UCM_002054_Article.jsp#.Wm9SDKinEdU.)

              View All References (3)

              Dietary guidelines for Americans 2005: Chapter 8 sodium and potassium. Washington, DC: U.S. Department of Agriculture, 2008. (Accessed on January 29, 2018 at https://health.gov/dietaryguidelines/dga2005/document/html/chapter8.htm.)

              Health threats from high blood pressure. Dallas, TX: American Heart Association. (Accessed on January 9. 2021 at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/LearnHowHBPHarmsYourHealth/Health-Threats-From-High-Blood-Pressure_UCM_002051_Article.jsp#.Wm9EhqinEdU.)

              Understanding blood pressure readings. Dallas, TX: American Heart Association. (Accessed on January 9. 2021 at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.Wm9R6KinEdU.)

              GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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