In this article:
- An increase in blood pressure inside the arteries is medically known as hypertension.
- The chances of developing problems in the heart, kidney, brain, and other diseases increase with high blood pressure.
- Approximately 1.13 billion people worldwide are affected by hypertension, of which two-thirds belong to middle- and low-income countries.
- Typically, hypertension does not present any symptoms and goes undiagnosed. It is one of the primary causes of premature deaths worldwide and is, thus, known as the “silent killer.”
- Hypertension can be easily managed with regular monitoring of blood pressure, medications, lifestyle changes, and self-care measures, which enable the patient to live a healthy and normal life.
When the blood is pumped through the arteries or blood vessels, it exerts a force against the walls of these tubal structures. This force, known as blood pressure, may become high at times, leading to hypertension, also called high blood pressure.
High blood pressure can be due to high sodium intake, certain medications such as over-the-counter cold relief drugs and birth control pills, health problems, smoking, obesity, stress, sedentary lifestyle, etc.
Additionally, hypertension often leads to an increased risk of aneurysm, stroke, heart attack, heart failure, and kidney damage.
In 2013, hypertension was the primary or contributing cause of more than 360,000 American deaths, averaging 1000 deaths every day. (1)
Measuring Blood Pressure
Determining blood pressure includes two measurements:
- Systolic pressure: The first number, which indicates the pressure generated when the heart contracts while pumping out the blood
- Diastolic pressure: The second number, which represents the pressure in the arteries when the heart relaxes between beats
Blood pressure may be measured using a digital blood pressure monitor, which takes the readings on its own and can be used at home.
Healthcare professionals use a medical device called a sphygmomanometer to measure blood pressure.
A bag or cuff is wrapped around the arm and inflated, increasing the pressure along with it, until the blood supply is cut off. It is followed by a gradual release of air so that the pressure decreases, reaching the point where blood flow restarts, giving the systolic reading. This is taken with the start of a pounding sound, which is heard using a stethoscope.
On further lowering of the pressure, the pounding stops once it goes beyond the diastolic pressure, giving the second reading.
A reading of 120/80 mmHg is the standard healthy reference. Blood pressure higher than 140/90 mmHg taken professionally or a reading of 135/85 mmHg or higher taken at home indicates hypertension.
If a patient has diabetes, then a pressure above 130/80 is considered hypertension. Extremely high blood pressures are fatal and thus require immediate medical attention.
Signs and Symptoms of High Blood Pressure
Hypertension typically does not present any symptoms. The body adjusts and becomes conditioned to functioning at a high blood pressure level, and this adaptation happens slowly over the years.
So, most people with hypertension have no symptoms and do not know that they have the condition. For this reason, hypertension is also known as the “silent killer.”
However, hypertension may present the following symptoms in a few cases:
- Excessive sweating
- Mild dizziness
These symptoms are common with a variety of diseases. Therefore, the only definite way to determine hypertension is by measuring blood pressure.
Diagnosis of High Blood Pressure
Your healthcare practitioner can diagnose hypertension by measuring your blood pressure. This quick, painless method involves the use of an inflatable cuff or bag that is wrapped and secured around your arm. The cuff is attached to a reading device that measures the pressure.
Because blood pressure varies throughout the day, it is recommended to measure it multiple times a day. Additionally, it is observed that sometimes blood pressure rises just because someone is taking a reading. Consult a doctor about the normal range.
Standard Medical Treatment
The majority of high blood pressure cases can be successfully managed with the help of medications.
A course of treatment will be devised based on the individual’s blood pressure levels and the assessment of risk factors contributing to cardiovascular problems such as stroke or heart attack.
On consultation, the doctor may advise a combination of the following methods to treat hypertension:
- Lifestyle changes: These changes help in managing the condition and preventing blood pressure from increasing. In some patients, blood pressure can go back to normal without the need for medication.
- Blood pressure monitoring: It is vital to track your blood pressure by measuring it at home, along with occasional visits to the clinic. To ensure the blood pressure machine you are using at home is accurate, you can bring it to your doctor’s office and compare the readings taken by the doctor and by your machine.
- Medications: Several classes of drugs can be used to treat hypertension, including:
- Calcium channel blockers
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin receptor blockers (ARBs)
- Aldosterone receptor antagonists
- Thiazide diuretics
All of these clinically tested and approved medications for the management of hypertension can have side effects. If you experience side effects from your antihypertensive drug, talk to your doctor so a different medicine will be prescribed.
You may need to take a combination of medications for effective treatment, depending on your blood pressure readings.
In rare cases, high blood pressure fails to respond to lifestyle changes and medications, warranting further investigation into the cause.
One cause of high blood pressure that is resistant to standard treatments is the narrowing of the arteries in your kidneys (renal artery stenosis). This can be treated through an angioplasty of the arteries in the kidneys.
At-Home Treatments to Manage High Blood Pressure
Several home remedies, in addition to lifestyle and dietary changes, can be done to manage high blood pressure naturally.
The following modifications in your lifestyle may aid treatment:
- Exercise regularly: Daily physical activity helps in lowering blood pressure and losing weight as well. It is recommended to do moderate-intensity aerobic exercises for 2.5 hours per week or high-intensity exercises for a total of 1.25 hours per week.
An easy way to break this down is to exercise for 30 minutes, 5 days a week. Any exercise that increases the needed oxygen supply and heartbeat, such as brisk walking, is recommended. Your doctor should clear you to begin an exercise routine based on your other medical problems.
- Avoid smoking: Nicotine in cigarettes is one of the major triggers of hypertension. Blood pressure returns to normal within 20 minutes of stopping cigarette smoking.
- Get proper sleep: Adequate rest, including 7-9 hours of sleep per day, is necessary to maintain good health.
- Consume alcohol in moderation: Excessive alcohol intake can increase your blood pressure over time. Refrain from drinking more than two servings of alcohol daily if you are a male and more than one serving if you are a female.
- Drink coffee in moderate amounts: Caffeine can contribute to an increase in blood pressure and, therefore, should be consumed in moderate amounts or cut out altogether.
- Maintain body weight: Excessive weight, or obesity, is a risk factor for cardiovascular problems, as it further strains the arteries and the heart. Therefore, consult a doctor for your ideal weight range and try to achieve it.
- Manage stress: Relaxation techniques, such as meditating, listening to music, exercising, and focusing on calming sources, can help in stress management. Reduced stress helps lower blood pressure and maintain physical and emotional health.
Taking the following measures to change your diet may help prevent increased blood pressure:
- Limit sodium intake: High intake of sodium is one of the major factors contributing to hypertension. Therefore, regulate the amount of sodium or salt you consume and limit it to 1500 mg per day. Additionally, it is recommended to increase your potassium intake. (2)
- Reduce fat consumption: Eat lesser amounts of foods containing saturated fats and cholesterol.
- Follow the DASH diet: The Dietary Approaches to Stop Hypertension include guidelines to a diet that helps in lowering blood pressure. (3) This eating plan was formulated after extensive research, funded by the National Heart, Lung, and Blood Institute (NHLBI) and includes:
- Increasing the amounts of fruits, vegetables, and whole-grain food products consumed
- Consuming low-fat or fat-free dairy products, nuts, beans, poultry, and vegetable oils
- Limiting the intake of food products with a high content of saturated fats, such as fatty meats, tropical oils (coconut, palm kernel, and palm oil), and full-fat dairy products
- Curtailing the intake of sweets and sugary drinks
Natural Remedies to Manage High Blood Pressure
The following food-based home remedies may help provide relief from hypertension:
The use of garlic for lowering blood pressure has been tested in various studies. Both cooked and raw garlic could help manage blood pressure by relaxing the arteries.
This effect may result from the release of hydrogen sulfide and nitric oxide gases that help dilate the arteries, thereby reducing the blood pressure.
A clinical trial conducted in 2013 showed that aged garlic extract is a safe agent for alleviating uncontrolled hypertension. Therefore, it can be used effectively in combination with other antihypertensive treatment methods. (4)
Another study conducted in 2014 demonstrated that the potency of aged garlic extract in lowering blood pressure was comparable to that of standard medications, demonstrating that it acts as a non-harmful treatment option for hypertensive individuals. (5)
How to use: Consume one or two crushed garlic cloves daily. Crushing the cloves stimulates the production of hydrogen sulfide and may be done by hand. If you are unable to eat garlic in its raw form due to the burning sensation, consume it along with milk.
While garlic has been shown to be effective in managing hypertension, long-term clinical studies are required to establish its role in cardiovascular mortality and morbidity.
Lemons help maintain the flexibility and softness of the blood vessels. As a result, the rigidity of the blood vessels decreases, leading to reduced blood pressure.
A study conducted in 2014 evaluated the effect of regular walking and lemon consumption on blood pressure levels. It was found that both factors contribute significantly to the management of blood pressure through different mechanisms. (8)
A randomized clinical trial conducted in 2016 showed the efficiency of consuming garlic and lemon juice in improving fibrinogen, lipid levels, and blood pressure in hyperlipidemia patients. (9)
How to use: Extract the juice from half a lemon and mix it with 1 cup of warm water. Drink this juice on an empty stomach every morning. Refrain from adding sugar or salt.
Lemon has been used for blood pressure management for a long time. While some studies support its role in the treatment of hypertension, the mechanism by which it helps lower blood pressure is not clearly understood. Large-scale trials are required to determine the dosage and efficacy.
The vasodilation properties of watermelon were elucidated in a pilot study published in 2011 in the American Journal of Hypertension. It was found that watermelon supplementation was beneficial for prehypertensive patients. (10)
A study published in 2016 demonstrated the use of watermelon extracts for the reduction of systolic and diastolic numbers in patients with blood pressure in a range of prehypertension and hypertension. However, their cardiac autonomic modulation was not affected. (11)(12)
A clinical trial conducted in 2019 reported that daily watermelon consumption for 4 weeks facilitated blood pressure and body weight reduction in overweight and obese participants. The fruit was also found to be a good source of antioxidants and helped improve the blood lipid profile. (13)
Replacing refined carbohydrate snacks with fresh watermelon aids weight management, reduces appetite, and also lowers the risk of cardiovascular problems. (13)
How to use: Include watermelon in your everyday diet. This fruit can also act as a substitute for desserts.
Watermelon consumption in appropriate amounts can be highly beneficial. While a large number of studies suggest a daily intake of watermelon or its extracts to manage hypertension, it is recommended to seek medical help as you may still need medication.
4. Black seed
Nigella sativa, or black seeds, has various health benefits and is nutritionally rich in vitamins, minerals, essential oils, and unsaturated fatty acids. It is also called the “seed of blessing” due to its diverse pharmacological properties that help treat hypertension, cardiac health problems, and even cancer. (14)
A randomized, double-blind, placebo-controlled clinical trial conducted in 2013 demonstrated the benefits of N. sativa. Healthy volunteers were administered 5 mL of black seed oil daily for 8 weeks, resulting in lowered blood pressures without any side effects. (15)
A 2016 review study elucidated the role of N. sativa supplementation in maintaining blood glucose levels. (16)
Another systematic review and meta-analysis of various trials published in 2016 evaluated the effects of N. sativa in blood pressure management. It was found that systolic and diastolic numbers of blood pressure can be lowered with a brief treatment of black seed powder. (17)
Research on the action of black seed at molecular levels needs to be conducted to help establish its efficacy as an antihypertensive agent.
Flaxseeds are rich in omega-3 fatty acids, fiber, and lignans and may help alleviate cardiovascular problems. Animal trials suggest that it can also be beneficial in peripheral artery disease, which is often associated with hypertension.
A study conducted in 2013 demonstrated flaxseed as a highly potent dietary antihypertensive agent. (18)
A meta-analysis carried out in 2015 concluded that eating flaxseed may help in the mild reduction of blood pressure. The potency was higher when flaxseed was consumed as a whole, for more than 12 weeks, especially for lowering diastolic blood pressure. (19)
The use of different flaxseed products in lowering systolic and diastolic pressure was evaluated in a systematic review and meta-analysis of controlled trials, published in 2016, giving positive results. (20)
A study published in 2019 revealed that according to the current data, flaxseed, flax lignan complex (FLC), and flax oil could not be considered as therapeutic agents. However, they may be used as adjuncts for the treatment of hypertension. (21)
More clinical trials are needed to determine the mechanism, efficacy, and dosage of flaxseeds.
Pomegranate, or Punicagranatum L., is a popular fruit consumed worldwide. It is one of the earliest edible fruits and has a variety of bioactive compounds. Extracts of pomegranate have potent antioxidative, anticarcinogenic, and antimicrobial effects.
A study published in 2011 stated that pomegranate juice might reduce systolic blood pressure, inhibit the activity of serum ACE, and offer various benefits for cardiovascular health in general. (22)
A double-blind, placebo-controlled, randomized clinical trial conducted in 2017 demonstrated that pomegranate is useful in controlling high blood pressure and can help prevent hypertension in an otherwise healthy population. (23)
A study published in 2018 reviewed multiple clinical trials and found that daily consumption of pomegranate juice aided relief from hypertension and helped reduce atherosclerosis. (24)
Long-term studies with larger samples are further required to determine the efficacy of pomegranate in relieving hypertension and using it as part of clinical treatments.
It is important to keep in mind that these natural remedies may not be sufficient to lower your blood pressure, and you may still need medication. As always, when you want to try a natural remedy, you should discuss it with your doctor.
Risk Factors for Hypertension
While it is difficult to detect the exact reason for high blood pressure in a majority of cases, the following factors may predispose you to hypertension:
- Family history: Genetics play a role in the development of high blood pressure.
- Age: Men above 35 and women above 45 years of age are more likely to have hypertension.
- Gender: Hypertension is more prevalent in men than in women.
- Smoking: Cigarette smoking increases the risk of high blood pressure conditions.
- Race: African-Americans are at the highest risk of hypertension, with 33% of the population affected, followed by Caucasians at 25%.
Complications Associated with Hypertension
Prolonged hypertension can cause organ damage and complications, such as:
- Cardiovascular diseases, including:
- Left ventricular hypertrophy
- Myocardial infarction or heart attack
- Heart failure
- Coronary artery disease
- Brain related problems, such as:
- Transient ischemic attack
- Vascular dementia
- Chronic kidney disease
- Cognitive changes
- Peripheral artery disease
How can high blood pressure increase the chances of stroke?
An increase in blood pressure causes excessive dilation and weakening of all blood vessels in the body, including those supplying blood to the brain.
Due to this strain, the walls of the blood vessels are damaged, leading to an increased risk of rupture or developing a clot, eventually leading to a stroke. In fact, high blood pressure is the number one cause of strokes.
Can one correctly check their blood pressure at home? How often should one check it?
With the development of various digital blood pressure monitors, it has become easy to measure your blood pressure at home. These devices are helpful for people who have already been diagnosed with hypertension or suspect it.
The AHA recommends the use of devices that have the upper arm cuff for accuracy, rather than finger or wrist blood pressure monitors.
Initially, you need to take your blood pressure reading twice a day for a week, once before taking your blood pressure medications in the morning and once in the evening. Following this, take one or two readings in a month, or as suggested by your doctor.
To ensure your blood pressure machine is accurate, you can also take it to your doctor’s office and compare the blood pressure reading of your machine with that of your doctor.
Can zinc deficiency cause high blood pressure?
A study published in the American Journal of Physiology – Renal Physiology reported that low levels of zinc had an impact on kidney function in mice. This led to altered sodium levels and contributed to hypertension. (25)
Is yoga helpful in the management of hypertension?
Various studies demonstrate the effectiveness of yoga in improving cardiovascular health. It works by decreasing the incidence of risk factors such as hypertension.
Daily yoga practice is known to help maintain low blood pressure. It is suspected that it restores the baroreceptor reflex, which plays a key role in maintaining blood pressure by sensing any blood pressure discrepancies. (26)
Yoga also helps in reducing the activity of the sympathetic nervous system while stimulating that of the parasympathetic system, leading to lower blood pressure. The breathing and meditation techniques involved in yoga exercises also aid relief from arterial hypertension. (27)
Is hypertension common in pregnancy? Does it cause any complications?
High blood pressure disorders associated with pregnancy affect about 6%-8% of women, causing significant complications. Pre-eclampsia, which is characterized by blood pressure elevation, can be life-threatening.
Hypertension in pregnancy may lead to premature birth and low birth weight or maternal mortality and morbidity.
Therefore, women with hypertensive pregnancy disorders should seek advice from a doctor and follow the suggested care plan. (28) The plan usually includes prenatal counseling, scheduled clinical visits, on-time delivery, proper intrapartum monitoring and treatment, and postpartum checkups.
The doctor will guide you at all times and also brief you on the possible risks to you or the fetus, helping you make the right decision. (28)
Can anxiety increase the chances of hypertension?
Prolonged anxiety, similar to hypertension, can cause problems in the blood vessels, heart, and kidneys.
A study conducted in 2015 suggested that anxiety may increase the chances of hypertension. While the mechanism is complex, anxiety in general, results in elevated blood pressure, sympathetic nervous system activity, increased blood lipid levels, increased plasma renin activity, increased systemic vascular resistance, and the homeostasis model. (29)
When to See a Doctor
Keep track of your blood pressure by getting it measured at a doctor’s clinic or daily at home, and get medical consultation if:
- It is in the prehypertension range, that is, between 120/80 mmHg and 139/89 mmHg. The doctor may suggest lifestyle changes, medications, or therapies to help manage the condition.
- It is constantly high (130/88 mmHg or above).
- The prescribed drugs and remedies are unable to lower the blood pressure.
- The medications to lower your blood pressure are causing side effects.
What you may ask your doctor:
- Does my medical history indicate a risk of having hypertension?
- Are there factors that put me at high risk for high blood pressure?
- What can I do to alleviate the condition?
- What dietary changes should I adopt to manage my blood pressure and maintain heart health in general?
- Is it alright for me to start an exercise routine to help manage my blood pressure?
- Is my high blood pressure caused by another medical condition?
What your doctor may ask you:
- Do any of your family members have hypertension?
- Do you smoke?
- Have you tried any dietary or lifestyle modifications?
- Do you take any prescription drugs?
- Do you take any OTC medicines, vitamins, or supplements?
- Do you have any health conditions?
High blood pressure (hypertension) can occur as a result of the narrowing, hardening, or constriction of arteries. Around 80 million Americans (33%) have hypertension, of which 16 million are unaware of the condition.
Patients with untreated cases of high blood pressure are at a high risk of having a stroke and heart attack.
Expert Answers (Q&A)
Answered by Yasmine S. Ali, MD, MSCI, FACC, FACP
Yes, excess weight (overweight and obesity) is absolutely a known cause of high blood pressure.
No, this has not been borne out in clinical studies.
Avoid salty foods and highly processed foods. Always try to eat a variety of fresh vegetables and fruits. A plant-based diet can help maintain or lower blood pressure.
Two diets that have been found to be particularly helpful are the DASH diet from the American Heart Association (DASH stands for “dietary approaches to stop hypertension”) (30) and the Mediterranean diet.
This is not a sustainable or recommended treatment for high blood pressure. If one is suffering from a hypertensive crisis, medical attention should be sought immediately as it is a medical emergency.
Regular physical activity, including staying in motion throughout the day as well as regularly scheduled aerobic and strength-training exercises, is recommended for a healthy lifestyle and has been found to help reduce or prevent high blood pressure.
Brisk walking for an hour, 5 days per week has been found to reduce death from cardiovascular causes, so that is a minimum to aim for. (31)(32)
Taking birth control pills may lead to high blood pressure, but depending on the type of pill, the age and other health conditions of the woman taking the pill, and other factors. This should be discussed with one’s gynecologist before beginning the medication.
Eat a healthy, well-balanced diet (such as the DASH and Mediterranean diets), and stay physically active. Be sure to take your blood pressure medications as prescribed.
About Dr. Yasmine S. Ali, MD, MSCI, FACC, FACP: Dr. Ali is a cardiologist and award-winning writer. She has published and reviewed health articles across a variety of media for over 20 years. She is a fellow of the American College of Cardiology (FACC) and the American College of Physicians (FACP).