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HIGH BLOOD PRESSURE OVERVIEW

Blood pressure refers to the pressure that blood applies to the inner walls of the arteries. Arteries carry blood from the heart to other organs and parts of the body. "Hypertension" is the medical term for high blood pressure.

WHAT IS BLOOD PRESSURE?

An individual's blood pressure is defined by two measurements:

● Systolic pressure is the pressure in the arteries produced when the heart contracts (at the time of a heartbeat)

● Diastolic pressure refers the pressure in the arteries during relaxation of the heart between heart beats

Blood pressure is reported as the systolic pressure over diastolic pressure (eg, 120/70 or "120 over 70").

Untreated high blood pressure increases the strain on the heart and arteries, eventually causing organ damage. High blood pressure increases the risk of heart failure, heart attack (myocardial infarction), stroke, and kidney failure.

HIGH BLOOD PRESSURE DEFINITION

The following definitions were proposed in 2017 by the American College of Cardiology/American Heart Association (ACC/AHA); other expert groups may differ slightly in how they define hypertension and when they recommend treatment.

Normal blood pressure  —  Less than 120 over less than 80.

Elevated blood pressure  —  120 to 129 over less than 80.

People with elevated blood pressure are at increased risk of developing hypertension and cardiovascular complications; however, medications used to treat hypertension are not known to be beneficial in people with elevated blood pressure.

Hypertension

● Stage 1: 130 to 139 over 80 to 89

● Stage 2: At least 140 over at least 90

Most adults with hypertension have primary hypertension (formerly called "essential" hypertension), which means that the cause of the high blood pressure is not known. A small subset of adults has secondary hypertension, which means that there is an underlying and potentially correctable cause, usually a kidney or hormonal disorder.

Prevalence of high blood pressure

Hypertension is a common health problem. In the United States, approximately 46 percent of adults have hypertension.

Hypertension is more common as people grow older. In the United States, for example, it affects 76 percent of adults aged 65 to 74 years and 82 percent of adults aged 75 years or older.

Unfortunately, many people's blood pressure is not well controlled. According to a national survey, hypertension was in good control in only 47 percent of adults.

HIGH BLOOD PRESSURE RISK FACTORS

Although the exact cause of primary hypertension remains unclear, several risk factors have been identified. Your risk is higher if you:

● Are older (the risk increases with advancing age)

● Have obesity

● Have a family history of hypertension (ie, relatives who had or have high blood pressure)

● Are a Black person

● Consume a lot of sodium (salt) in your diet

● Drink a lot of alcohol

● Do not get a lot of physical activity

HIGH BLOOD PRESSURE SYMPTOMS

High blood pressure does not usually cause any symptoms.

HIGH BLOOD PRESSURE DIAGNOSIS

Hypertension is often identified through routine screening. Experts recommend that people 40 years and older without a history of hypertension have their blood pressure checked once a year; screening should happen more frequently in people with risk factors such as obesity or family history, or who have had elevated blood pressure in the past. For younger people without risk factors, screening every few years may be a reasonable approach.

If your blood pressure is found to be elevated or high during in-office screening, you may be asked to confirm the results by checking your blood pressure yourself at home. This is because in many cases, a person's blood pressure temporarily increases when it is taken by a doctor, nurse, or other medical professional in the office setting. This is sometimes called "white coat hypertension." Your health care provider will use the readings from your in-office blood pressure check and your at-home results to determine whether or not you have true hypertension.

HIGH BLOOD PRESSURE TREATMENT

Untreated hypertension can lead to a variety of complications, including heart disease and stroke. The risk of these complications increases as your blood pressure rises above 115/75, which is still in the normal range. Treating high blood pressure can reduce your risk of heart attack, stroke, and death.

Lifestyle changes  —  Treatment of hypertension usually begins with lifestyle changes. Making these lifestyle changes involves little or no risk. Recommended changes often include:

● Reduce the amount of salt in your diet

● Lose weight if you are overweight or have obesity

● Avoid drinking too much alcohol

● Stop smoking

● Exercise at least 30 minutes per day most days of the week

These changes are discussed in detail in a separate article. (See "Patient education: High blood pressure, diet, and weight (Beyond the Basics)" .)

Medicine  —  A medicine to lower blood pressure may be recommended if your blood pressure is consistently high, usually at or above 140/90. Treatment with medicine is recommended at a lower blood pressure for some older people and for those with atherosclerosis (fatty deposits lining the arteries, as in coronary heart disease, stroke, or peripheral artery disease), diabetes, or chronic kidney disease complicated by protein in the urine. (See "Patient education: Type 1 diabetes: Overview (Beyond the Basics)" and "Patient education: Type 2 diabetes: Overview (Beyond the Basics)" and "Patient education: Chronic kidney disease (Beyond the Basics)" .)

High blood pressure medicines are discussed in a separate article. (See "Patient education: High blood pressure treatment in adults (Beyond the Basics)" .)

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site ( www.uptodate.com/patients ). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information  —  UpToDate offers two types of patient education materials.

The Basics  —  The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: High blood pressure in adults (The Basics) Patient education: Controlling your blood pressure through lifestyle (The Basics) Patient education: Understanding your risk of high blood pressure (The Basics) Patient education: Lowering your risk of heart disease (The Basics) Patient education: Checking your blood pressure at home (The Basics) Patient education: Preeclampsia (The Basics) Patient education: Polycystic kidney disease (The Basics) Patient education: The ABCs of diabetes (The Basics) Patient education: Exercise and movement (The Basics) Patient education: High blood pressure and pregnancy (The Basics) Patient education: Renovascular hypertension (The Basics) Patient education: High blood pressure emergencies (The Basics) Patient education: Aortic dissection (The Basics) Patient education: Coronary artery disease in women (The Basics) Patient education: Medicines for chronic kidney disease (The Basics) Patient education: DASH diet (The Basics) Patient education: Blood pressure measurement (The Basics) Patient education: Carotid ultrasound (The Basics) Patient education: Diabetes and heart disease (The Basics)

Beyond the Basics  —  Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: High blood pressure, diet, and weight (Beyond the Basics) Patient education: Type 1 diabetes: Overview (Beyond the Basics) Patient education: Type 2 diabetes: Overview (Beyond the Basics) Patient education: Chronic kidney disease (Beyond the Basics) Patient education: High blood pressure treatment in adults (Beyond the Basics)

Professional level information  —  Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Out-of-office blood pressure measurement: Ambulatory and self-measured blood pressure monitoring Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults Diagnosis of primary aldosteronism Tapering and discontinuing antihypertensive medications Cardiovascular risks of hypertension Choice of drug therapy in primary (essential) hypertension Definition, risk factors, and evaluation of resistant hypertension Diet in the treatment and prevention of hypertension Moderate to severe hypertensive retinopathy and hypertensive encephalopathy in adults Initial evaluation of adults with hypertension Management of severe asymptomatic hypertension (hypertensive urgencies) in adults Overview of hypertension in adults Medication adherence in patients with hypertension Perioperative management of hypertension Renin-angiotensin system inhibition in the treatment of hypertension Salt intake and hypertension Establishing the diagnosis of renovascular hypertension Prevention of cardiovascular disease events in those with established disease (secondary prevention) or at very high risk Spontaneous intracerebral hemorrhage: Pathogenesis, clinical features, and diagnosis Spontaneous intracerebral hemorrhage: Acute treatment and prognosis Hypertension in adults: Blood pressure measurement and diagnosis Metabolic syndrome (insulin resistance syndrome or syndrome X) The prevalence and control of hypertension in adults Antihypertensive therapy for secondary stroke prevention Treatment of hypertension in patients with diabetes mellitus Treatment of hypertension in patients with heart failure Treatment of hypertension in older adults, particularly isolated systolic hypertension Treatment of resistant hypertension Goal blood pressure in adults with hypertension Evaluation of secondary hypertension

The following organizations also provide reliable health information.

● National Library of Medicine

( www.medlineplus.gov/healthtopics.html )

● National Heart, Lung & Blood Institute (NHLBI)

( www.nhlbi.nih.gov )

● American Heart Association

( www.heart.org )

ACKNOWLEDGMENT

We are saddened by the death of George Bakris, MD, who passed away in June 2024. UpToDate acknowledges Dr. Bakris'sc past work as a section editor for this topic.

• MacMahon S. Blood pressure and the risk of cardiovascular disease. N Engl J Med 2000; 342:50.
• Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345:1291.
• Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995; 25:305.
• Hebert PR, Moser M, Mayer J, et al. Recent evidence on drug therapy of mild to moderate hypertension and decreased risk of coronary heart disease. Arch Intern Med 1993; 153:578.
• Stergiou GS, Palatini P, Parati G, et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J Hypertens 2021; 39:1293.
• Whelton PK, Carey RM, Aronow WS, 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: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2018; 138:e426.
• Whelton PK, Carey RM, Mancia G, et al. Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension Blood Pressure/Hypertension Guidelines. Eur Heart J 2022; 43:3302.

Hypertension Patient Education

Blood pressure and hypertension education: tools and handouts.

The Preventive Cardiovascular Nurses Association has developed a series of blood pressure and hypertension education handouts to support your efforts to help patients and caregivers manage hypertension.

All materials are available in both English and Spanish.

Booklet: How Do You Measure Up?

Help patients understand hypertension and what they can do to improve blood pressure. The easy-to-understand language, charts, and checklists help patients track their progress and follow a healthy lifestyle.

Updated August 2024

Free to download (login required)

Download the Tool

Download the Tool Don't have an account? Register now.

Measuring Tape for Blood Pressure Cuff

This free download can be used to determine the appropriate size blood pressure cuff for accurate measurement.

Fact Sheet: High Blood Pressure

This companion piece summarizes strategies to control blood pressure, including:

• Understanding blood pressure numbers
• Cardiovascular risk management
• Reducing sodium consumption
• Selecting and using a home blood pressure monitor
• Understanding medications

Disclaimer: This and other PCNA educational materials are for information purposes only and are not intended to replace medical advice or diagnose or treat health problems. Health-related decisions should be made in partnership with a healthcare provider. It is the reader's responsibility to seek out the most current, accurate information.

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April 10-12, 2025.

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Monitoring your blood pressure at home.

You can’t feel high blood pressure. Known as “the silent killer,” it can have devastating effects in your body but is undetectable without using a blood pressure measuring device.

High blood pressure affects nearly half of adults in the United States and is a major risk factor for heart attack, heart failure, stroke and kidney disease.

Why Your Blood Pressure Matters

The first step in detecting and controlling high blood pressure is to have it checked by a health professional during a physical exam.

Blood pressure categories defined by the American Heart Association are:

If you’ve already been diagnosed with high blood pressure or have had a stroke, heart failure or kidney disease, maintaining strict control of your blood pressure (BP) can be lifesaving, so it’s wise to routinely keep track of it yourself at home. Plus, if getting anxious in a doctor’s office makes your BP go up (called “white coat hypertension”), measuring blood pressure in a calm, relaxing environment at home can provide a more accurate reading.

Blood pressure machines in public places, such as drugstores, are convenient but may not be totally accurate. If you use a public BP machine and receive a high result (over 120/80), be sure to see your doctor to have this reading verified.

Self-Measured Blood Pressure Monitoring

Self-measured blood pressure monitoring, recommended by the American Heart Association , helps you and your doctor keep better track of your blood pressure and gives you an active role in the process. Here’s how to do it:

• Buy a monitor with an arm cuff. Don’t buy a monitor with a wrist or finger cuff, which are not as accurate. Before you buy, use a string or measuring tape to measure around the circumference of your upper arm, halfway between your elbow and shoulder, to be sure the cuff will fit.
• Make sure your monitor works correctly. When choosing a BP monitor, be sure it’s been validated for accuracy and reliability. Bring it in to your healthcare team when you first buy it and then once a year afterward. In addition, bring your monitor to get checked if your home measurements are regularly 10 mmHg different (higher or lower) than those at your healthcare visits.
• Be consistent. Measure BP at least three times per week unless otherwise directed, and measure at the same place and time. Good times to measure are in the morning before taking medications and in the evening before dinner.
• Know your goal. Talk to your healthcare team about what your BP goal should be. A common goal is a systolic blood pressure (top number) lower than 140 and a diastolic (bottom number) lower than 90. In some cases, your provider may set your target BP to be lower than that.
• Keep a log. Track your blood pressure with the date, time, reading and notes. Share your log with your healthcare team at all regular visits.
• Look for patterns. If your measurements go up and down, try to understand why. Was there anything different about your day? Your BP can be affected by many things, such as changes in your medication, salt in your food, caffeine, alcohol, physical activity and stress.

How To Monitor Blood Pressure Correctly

Follow these steps to correctly measure your blood pressure. If you have questions, contact your healthcare team.

• Don’t drink caffeine (such as coffee), exercise or smoke for at least 30 minutes before taking your blood pressure.
• Use the restroom and empty your bladder before sitting down.
• Sit comfortably with both feet flat on the floor for five minutes before taking your blood pressure. Sit with your back straight and supported (on a dining chair, for example, instead of a sofa).
• Rest your arm on a table so the blood pressure cuff is about the same height as your heart (the middle of your chest). Unless otherwise directed, you may use either arm, but use the same arm each time.
• Wrap the cuff around your bare upper arm (not over clothing). Place the bottom of the cuff directly above the bend of the elbow.
• Don’t talk or do other activities while measuring your blood pressure.
• Follow the instructions for your monitor to take two to three readings at least one minute apart.
• In your log, write down all your measurements, including the date, time of day and comments about daily activity, food and emotions.

Be sure to see your healthcare provider if you’re consistently having high blood pressure readings at home.

Helpful Resources

• High Blood Pressure Forms and Handouts

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Find High Blood Pressure Tools and Resources

The tools offered here can help you learn about and manage your blood pressure. 

About Blood Pressure

• Let's Talk About Blood Pressure e-Learning Module  |  Hablemos sobre presión arterial
• What Is High Blood Pressure? (PDF) | ¿Qué es la presión arterial alta? (PDF)
• High Blood Pressure and Black People (PDF)
• High Blood Pressure and Stroke (PDF)
• Blood pressure readings chart: English (PDF) |  Spanish (PDF)  | Traditional Chinese (PDF)
• Consequences of HBP infographic: English (PDF) |  Spanish (PDF) | Traditional Chinese (PDF)  | Simplified Chinese (PDF)
• BP Raisers infographic: Things that could raise your blood pressure (PDF)
• Guide for Talking to Your Health Care Professional  |  Ver la guía (PDF)

Managing Blood Pressure

• How to Measure Your Blood Pressure: English (PDF) | Spanish (PDF)  | Traditional Chinese (PDF)  | Simplified Chinese (PDF)
• Printable Blood Pressure Tracker (PDF)  
• What Is High Blood Pressure Medicine? (PDF) | ¿Qué son los medicamentos para la presión arterial alta? (PDF)
• How Can I Reduce High Blood Pressure? (PDF) | ¿Cómo puedo reducir la presión arterial alta? (PDF)
• Why Should I Limit Sodium? (PDF)  |  ¿Por qué debería limitar el consumo de sodio? (PDF)
• Lifestyle Chart: What can I do to improve my blood pressure? English (PDF) | Spanish (PDF)  | Traditional Chinese (PDF)  | Simplified Chinese (PDF)
• Support Network  – An online community to connect with others.

Materials for Health Care Professionals

• Hypertension Guideline Resources
• Target: BP™
• Achieving Accuracy: BP Measurement E-Module
• Hypertension and Nephrology Community

Last Reviewed: May 7, 2024

Let's Talk About Blood Pressure

In this free learning tool , you can learn:

• The risks of high blood pressure
• How self-monitoring can help control high blood pressure

Explore and download free information along the way.

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How to check your blood pressure at home

• Healthy aging
• Heart & circulation

Monitoring your blood pressure helps you manage your long-term health — but are you sure the results are accurate? Avoid these common mistakes to get more reliable readings.

Your blood pressure measures how hard your blood is pushing against the walls of your arteries as it’s pumped through your body by your heartbeats.

“Being aware of your blood pressure gives you insight into your heart health and can alert you of potentially undetected problems,” says Maria Kobylinski, MD , an internal medicine physician at Geisinger. 

Because routine monitoring can help you and your doctor detect changes and help you keep your blood pressure at a healthy level, it’s smart to keep track. But you want to make sure you’re getting an accurate reading. Here’s how.

Common mistakes that skew your blood pressure reading

Even small missteps when measuring blood pressure can throw off your reading, whether at home or in the doctor’s office. These include:

• Wrong cuff size
• Incorrect arm placement
• Legs crossed or feet dangling
• Momentary stress (sometimes called “white coat syndrome”)

Research shows that your arm resting in your lap or hanging by your side can inflate your numbers by around 4 mmHg (millimeters of mercury — the standard unit of measurement for blood pressure). And if the blood pressure cuff is the wrong size, that can impact it by as much as 30 mmHg. “White coat syndrome,” or the temporary stress that some people feel in a clinical setting, can also skew your results. 

Knowing how to correctly measure blood pressure could help keep you from being prescribed unnecessary medications due to misdiagnosed high blood pressure (also called hypertension).

Monitoring your blood pressure at home also means you’ll stay informed about your personal health baselines — it’s empowering to know what your normal blood pressure is.  

How to check your blood pressure at home the right way

First, you’ll need an at-home blood pressure monitor. These devices are relatively inexpensive and available at most pharmacies . “Choose a monitor that fits on your upper arm, not your wrist,” says Dr. Kobylinski. “Many patients don’t realize this, but you can bring your monitor to your next doctor appointment to make sure it’s right for you. Your clinician can even teach you how to use it properly.”

Here’s how to correctly take your blood pressure at home:

• Proper arm position: Arm placement is crucial. Your arm must be supported, such as resting on a desk, with the cuff positioned at about heart level on your arm. Do not let your arm rest in your lap or hang by your side when testing. “Always measure your blood pressure on your upper arm, above the elbow,” says Dr. Kobylinski.
• Correct cuff size: Like Goldilocks, you may need to go on a quest to find a cuff that fits just right. Cuff sizes range from small to extra-large, but many at-home monitors are sold with only one size option — which may not be right for you. Your personal cuff size depends on your arm circumference. The American Heart Association recommends that the cuff be around 80% of the arm's circumference, and wide enough to cover 40% to 80% of the distance from the elbow to the shoulder. 
• Not too tight: Even when the cuff fits just right, correct placement and tightness is just as important. Make sure it’s tightly secure, but not uncomfortable. When the cuff inflates, you should be able to fit only two fingertips under its top edge, and your skin shouldn't pinch.
• Skip the sleeves: Put the cuff on over your bare skin. Clothing underneath it could skew your results, particularly when you’re at home doing it yourself. If you need to roll up your sleeve, make sure it’s not so tight that your skin bunches, as this could affect your reading too.
• Feet flat on floor: Never cross your legs when taking blood pressure, and don’t let your feet dangle above the floor when seated. For an accurate test, sit up straight but comfortably, with both feet resting flat on the floor. Relax for at least 5 minutes in this position before taking your reading.
• Time it right: Avoid tobacco, caffeine and exercise 30 minutes beforehand. Time of day may also be a factor. “Blood pressure is usually highest in the morning and lowest during sleep,” says Dr. Kobylinski. That’s why you may be asked to measure twice a day, in the morning and evening. 

How reliable are at-home blood pressure monitors?

“Using the right monitor for you and avoiding the common mistakes that can skew your readings should allow you to do fairly accurate tests at home,” says Dr. Kobylinski. Being in your familiar home environment can also help you sidestep the “white coat hypertension” of being tested in a clinic. 

For extra accuracy, measure your blood pressure 2 or 3 times and use the average number for your records. Be sure to include the date and time of the test whenever recording your readings.

“It’s best to follow your doctor’s recommendations, and remember that home blood pressure monitoring is not a substitute for medical visits,” Dr. Kobylinski says.

How to read your blood pressure results

Your blood pressure measurements will include 2 numbers: 

• Systolic (top number) = pressure in blood vessels when the heart beats
• Diastolic (bottom number) = pressure in blood vessels when heart relaxes between beats 

The American Heart Association (AHA)  categorizes 5 levels of blood pressure for most adults, with a normal reading being anything less than 120/80 mmHg. 

“For people over age 60, you want to aim for the systolic number to be less than 150 and the diastolic number less than 90,” says Dr. Kobylinski.

Tips for controlling high blood pressure 

High blood pressure often has no signs or symptoms, but you can take steps to control it: 

• Take your medicine as directed
• Eat lots of fresh fruits and low-fat dairy products 
• Limit saturated and total fat
• Cut down on salt and sodium
• Quit tobacco
• Limit alcohol and caffeine
• Maintain a healthy weight
• Get regular exercise
• Control stress

Benefits of tracking your blood pressure at home  

It’s natural for your blood pressure to change over time. However, if you develop hypertension that’s left untreated, your risk of developing certain health issues can increase. 

High blood pressure can lead to health issues including:  

• Heart attack 
• Stroke 
• Heart failure
• Kidney failure  

“If your blood pressure is suddenly extremely high, or has been consistently higher for a period of time, call your doctor,” says Dr. Kobylinski. “The longer your blood pressure remains high, the higher your risk for a heart attack or stroke.” 

By measuring your blood pressure at home daily, you can become your doctor’s partner in staying on top of health issues so you can live a long and healthy life. 

Next steps:

Get help  managing your blood pressure What's the  best exercise for high blood pressure? How to take  cold medicine with high blood pressure 

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How to Use Your Blood Pressure Monitor (Patient Education Video, English) 

Apr 25, 2018.

This patient education video provides instructions on the correct use of a home blood pressure monitor. This allows patients to share accurate blood pressure readings with their providers as part of a health center’s self-measured blood pressure (SMBP) program. (English)