High Blood Pressure

What is high blood pressure?

Blood pressure is the force of blood pushing against the walls of your arteries. It is written as two numbers — the systolic pressure (when the heart beats) over the diastolic pressure (when the heart relaxes between beats). When that force stays too high over months and years, it slowly damages the arteries, the heart, the kidneys, the eyes, and the brain.

High blood pressure is often called a silent condition because most people feel completely normal. It is usually found on a routine reading, not because of a symptom.

What do the numbers mean?

Current guidelines from the American College of Cardiology and American Heart Association group readings this way:

• Normal — below 120 systolic and below 80 diastolic
• Elevated — 120–129 systolic and below 80 diastolic
• Stage 1 hypertension — 130–139 systolic or 80–89 diastolic
• Stage 2 hypertension — 140 or higher systolic, or 90 or higher diastolic

A reading above 180/120 needs urgent attention. If you get a reading that high, especially with chest pain, shortness of breath, weakness, vision change, or difficulty speaking, treat it as an emergency and call 911.

One high reading does not by itself mean you have hypertension. Diagnosis is based on multiple readings over time, and often on readings taken at home, because blood pressure naturally varies through the day.

Why does it matter if I feel fine?

Because the damage accumulates quietly. Untreated high blood pressure is a leading contributor to heart attack, stroke, heart failure, kidney disease, and vision loss. It also thickens and stiffens the heart muscle over time. Treating it is one of the most effective things in all of medicine for preventing those outcomes — and the benefit comes without you ever feeling the disease it prevented.

How is high blood pressure evaluated?

A cardiology evaluation confirms the diagnosis with accurate readings, looks for causes that can be corrected, and checks whether the heart and other organs have already been affected. That may include blood work, an EKG, and an echocardiogram to look at the heart muscle's thickness and function. Home blood pressure monitoring is often part of the picture, since readings taken at home are frequently more representative than a single reading in a clinic.

How is it treated?

Treatment combines lifestyle measures with medication when needed. Lifestyle changes that lower blood pressure meaningfully include reducing sodium, following an eating pattern rich in vegetables and fruit, regular physical activity, limiting alcohol, losing excess weight, and treating sleep apnea if present.

Many people also need medication, and there are several well-established classes that work in different ways. Finding the right one, or the right combination, is often a process of adjustment over a few visits. The goal is a target that fits your overall health, not a single number for everyone.

This page is general health information, not medical advice. It cannot replace an evaluation by a physician who knows your history. Talk with your cardiologist or primary care physician about what applies to you.