Understanding your blood pressure measurement
When you have a blood pressure reading, the doctor will tell you two numbers: the systolic blood pressure (SBP) over the diastolic blood pressure (DBP). Use the following chart to compare your SBP and DBP numbers and find out if your blood pressure is normal, elevated, or high. If your SBP and DBP fall into different categories, use the higher category (for example, if your blood pressure is 130 over 75, you’re in stage 1 of high blood pressure).
| Category | SBP (in mm Hg) | DBP (in mm Hg) | What to Do | |
|---|---|---|---|---|
| Normal | Less than 120 | and | Less than 80 | Have your blood pressure rechecked in two years. |
| Elevated blood pressure | 120–129 | and | Less than 80 | Modify your lifestyle and have your blood pressure monitored. |
| High blood pressure, stage 1 | 130–139 | or | 80–89 | Modify your lifestyle and have your blood pressure monitored. Talk with your doctor about your risk of heart attack and stroke and consider taking medications to lower your blood pressure. |
| High blood pressure, stage 2 | 140 or greater | or | 90 or greater | Modify your lifestyle and have your blood pressure monitored. Talk with your doctor about your risk of heart attack and stroke and take medications to lower your blood pressure. |
How to prevent or reduce high blood pressure
If you’ve been diagnosed with elevated or high blood pressure, you can make lifestyle changes to lower your blood pressure to a healthy level:
- Adopt the DASH diet.
- Reduce your sodium intake.
- Quit smoking.
- Limit your consumption of alcohol.
- Cut down or eliminate your caffeine intake.
- Start an exercise program and stick with it.
- Use mind-body techniques, such as yoga and meditation.
- Avoid medications that raise blood pressure, like steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and certain diet pills.
- Take blood pressure medications regularly if your doctor has prescribed them.
Evidence of resistant high blood pressure
Resistant high blood pressure is a result of a specific medical condition. After the underlying condition is treated, your blood pressure will typically return to normal. The following signs may indicate you have resistant high blood pressure:
- Onset of high blood pressure before age 20 or after the age of 50
- Flushing spells
- Rapid pulse
- Intolerance to heat
- Very high blood pressure (over 180/120)
- Damage to the eyes, kidneys, or heart
- Low level of potassium in the blood
- Loud humming sound in the abdomen (called a bruit)
- Family history of kidney disease
- Poor response to medications that are usually effective
Assessing high blood pressure medications
If you’ve wholeheartedly made lifestyle changes trying to reduce your high blood pressure and it doesn’t seem to be working, you may need high blood pressure medication. Numerous medications exist for high blood pressure, but you need to meet with your health-care provider to discuss what medicine is right for you. Medications for high blood pressure fall into several classes:
- Angiotensin-converting enzyme (ACE) inhibitors: These medications lower blood pressure by blocking the formation of a key hormone, angiotensin II, which both narrows arteries and causes the release of another blood-pressure-raising hormone. They’re first-line medications for the treatment of high blood pressure.
- Angiotensin II receptor blockers: These medications lower blood pressure by preventing angiotensin II from attaching to a receptor site. They’re also first-line medications for the treatment of high blood pressure.
- Beta blockers: These medications lower blood pressure by decreasing the amount of blood pumped by the heart and by lowering the heart rate. They’re only indicated for the treatment of high blood pressure if there is a history of recent heart attack or heart failure.
- Calcium-channel blockers: These medications lower blood pressure by preventing calcium from entering cells, thus increasing (or dilating) the size of arteries. They’re also first-line medications for the treatment of high blood pressure.
- Diuretics: These medications lower blood pressure by causing salt loss in the urine with accompanying body water, thereby reducing blood volume and pressure. A specific diuretic class, the thiazide diuretics, is also first line for the treatment of high blood pressure.