High Blood Pressure (Hypertension)

Treatment for high blood pressure depends on the severity of the disease and whether you have other health problems, such as heart failure or diabetes. Your doctor may want you to try lifestyle changes first, including losing weight, increasing activity, and eating a balanced diet. If your blood pressure is above a certain level, your doctor may prescribe medicine along with the lifestyle changes.

Some people may only need lifestyle changes to control their high blood pressure, while others need medicine as well. Either way, treating high blood pressure usually is a lifelong process.

Treatment of primary high blood pressure, especially moderate or severe high blood pressure, decreases the risk of heart failure, coronary artery disease, heart attack, abnormal heartbeats, stroke, and kidney disease, and it reduces the risk of death from these conditions.

Overall, goals of treatment are to:

• Prevent death and disease associated with high blood pressure (heart disease, stroke, and kidney disease).
• Reduce systolic blood pressure below 140 millimeters of mercury (mm Hg) and diastolic blood pressure below 90 mm Hg. The blood pressure goal may be lower, less than 130/80 mm Hg, for people with certain health conditions like diabetes, kidney disease, heart failure, or coronary artery disease.
• Control other risk factors, such as smoking, lack of exercise, and high cholesterol, that can lead to complications such as a heart attack and stroke.
• Minimize side effects of medicines.
• Live a full and active life.

Initial treatment

If you fall into the prehypertension range (120–139/80–89), your doctor will likely recommend lifestyle changes, including:

• Losing excess weight.
• Exercising.
• Limiting alcohol to 2 drinks a day for men and 1 drink a day for women.
• Cutting back on salt.
• Quitting smoking.
• Following the Dietary Approaches to Stop Hypertension (DASH) diet.

The DASH eating plan is a low-fat and low-saturated-fat diet that emphasizes eating more fruits, vegetables, whole grains, and low-fat dairy foods. For more information, see:

High blood pressure: Using the DASH diet.

If you have high blood pressure (140–159/90–99 mm Hg) and you do not have any organ damage or other risk factors for heart disease (this is called uncomplicated high blood pressure), your doctor will likely recommend lifestyle changes and possibly medicines. Most people with high blood pressure will need two or more medicines, including a thiazide-type diuretic, to lower their blood pressure to below 140/90 mm Hg, which is the goal for people with uncomplicated hypertension. If you have other conditions, such as diabetes, heart failure, coronary artery disease, or chronic kidney disease, your doctor may recommend that your blood pressure should be less than 130/80. For more information, see:

Should I take medicines for high blood pressure?

If your blood pressure is 160–179/100–109 mm Hg or higher, you may need to try various combinations of medicines to find what works best for you. You will also need to make aggressive lifestyle changes.

For more information on medicines, see:

High blood pressure: Taking medicines properly.

Treatment of secondary high blood pressure varies depending on the cause. For example, treatment of high blood pressure caused by kidney disease will also include treating the kidney problem. If you have secondary high blood pressure, you may have to take blood pressure medicine long term, even if the condition that is causing your high blood pressure is treated.

For more information, see the high blood pressure guidelines from the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

People with high blood pressure who require special treatment considerations include:

• Older adults.
• African Americans.
• Children.
• Pregnant women.

Ongoing treatment

Most cases of high blood pressure cannot be cured but can be controlled with lifestyle changes and medicine. Treatment is a lifelong process.

You may need to try several different medicines or combinations of medicines, such as ACE inhibitors and diuretics, before finding the right combination that lowers your blood pressure to a safe level. If you have secondary high blood pressure, you may need treatment for the condition that is causing your high blood pressure. For more information on medicines, see:

High blood pressure: Taking medicines properly.

You may need to work with a registered dietitian to successfully follow the Dietary Approaches to Stop Hypertension (DASH) diet. For more information, see:

High blood pressure: Using the DASH diet.

It is important to follow the lifestyle changes your doctor recommends for the rest of your life to reduce your risk of heart disease and stroke.

People with heart disease and high blood pressure have a high risk for future heart problems and need aggressive treatment.

Treatment if the condition gets worse

Untreated high blood pressure can lead to fatal heart attacks or strokes. The higher your blood pressure, the greater your risk for these complications. Lowering blood pressure reduces the risk of damaging blood vessels and developing atherosclerosis.

As your high blood pressure rises, you may need to take higher doses of medicine or a combination of medicines. Many people take a combination of several medicines.

For more information, see:

High blood pressure: Taking medicines properly.

What to Think About

In older adults, even small decreases in systolic blood pressure may be enough to prevent complications, if their diastolic blood pressure is normal.

People who have high blood pressure are encouraged to make lifestyle changes and stay with these changes for the rest of their lives to reduce their blood pressure. Lifestyle changes such as eating a low-fat diet, quitting smoking, and exercising will help reduce the overall risk of heart disease and stroke and may reduce blood pressure significantly.