How to Lower High Blood Pressure (Hypertension): What Blood Pressure is Normal?

What is Blood Pressure?

Blood pressure is defined as the force of blood that pushes against your artery walls. Your heart generates this force by pumping out blood through your arteries when it contracts with every heartbeat. As your blood flows, it places pressure on the artery walls, creating blood pressure.

Your blood pressure reading is measured as 2 values that determine whether your blood pressure is normal, high, or low:

1. Systolic pressure: A force that develops as blood pumps out of your heart and into the circulatory system's arteries when your heart beats. It is the top and higher number on your reading.

2. Diastolic pressure: A force that's produced when your heart rests between heartbeats. It is the bottom and lower number on your reading.

Blood pressure is essential because, without this force, oxygen and nutrients wouldn't be able to move around the circulatory system, causing a lack of nourishment to tissues and organs.

What is High Blood Pressure?

High blood pressure (HBP), commonly known as hypertension, is a condition that occurs when the force of your blood pushing against the walls of your blood vessels is continuously too high.

HBP is referred to as the “silent killer” because it may be asymptomatic (no symptoms), which can delay diagnosis and contribute to medication non-adherence in those being treated for HBP. Although you may not feel that anything is wrong, HBP silently harms your health.

Uncontrolled HBP increases your risk of critical health problems, such as heart problems, including stroke and heart attack, as well as kidney failure.

How is HBP Diagnosed?

HBP is diagnosed by an inflatable arm cuff that's placed around your arm by your doctor and/or nurse, and it measures your blood pressure using a pressure-measuring gauge. This blood pressure monitor provides 2 numbers that make up your blood pressure; your systolic and diastolic readings.

Your blood pressure measurements may consist of these categories:

• Normal blood pressure: Your blood pressure is considered normal if it’s less than 120/80 mm Hg (120 systolic over 80 diastolic).
• Elevated blood pressure: Your blood pressure is considered elevated, also referred to as “prehypertension,” if your systolic pressure ranges from 120-129 mm Hg, and your diastolic pressure is below 80 mm Hg. If appropriate actions aren't taken to control your elevated blood pressure, it may worsen over time.
• Stage I hypertension: Your blood pressure falls into HBP, stage 1, if your systolic pressure ranges from 130-139 mm Hg or your diastolic pressure ranges from 80-89 mm Hg.
• Stage II hypertension: Your blood pressure is considered more severe if your systolic pressure is 140 mm Hg or higher or your diastolic pressure is 90 mm Hg or higher.
• Hypertensive crisis: If your blood pressure measurement is higher than 180/120 mm Hg, it is considered an emergency situation that requires urgent medical attention.
  If you receive this outcome after measuring your blood pressure at home, wait 5 minutes and then test again. If your blood pressure is still so high, call your doctor right away. If you experience any chest pain, vision problems, numbness and/or weakness, dyspnea (difficulty breathing), or other signs or symptoms of a stroke or heart attack, call 911 or your nearest emergency medical number.

How Do I Know If I Have HBP?

HBP may not have any symptoms, even if your blood pressure readings become too high. That’s why it is crucial to have your blood pressure checked regularly.

Although these symptoms are not specific to HBP, if your blood pressure is dangerously high, you may want to watch for signs that include:

• Nosebleed
• Confusion and/or fatigue
• Vision issues
• Severe headaches
• Chest pain
• Difficulty breathing
• Irregular heartbeat
• Blood in the urine

How Can I Prevent HBP?

Lifestyle modifications can help you maintain healthy blood pressure and prevent HBP. Here's what you can do:

• Maintain a healthy body weight based on your doctor’s recommendation. Losing weight if you’re overweight, or maintaining a healthy weight can aid in blood pressure control and decrease your risk of serious health problems.
• Eat a balanced diet. You should maintain a heart-healthy diet, such as eating more fruits and vegetables. This type of diet is referred to as the Dietary Approaches to Stop Hypertension (DASH), which consists of fruits, vegetables, whole grains, poultry, fish, and low-fat dairy foods. Reducing saturated fat and trans fat in your diet, as well as consuming more potassium, such as bananas and spinach, can help you maintain a balanced diet.
• Decrease sodium in your diet, such as salt intake. Your salt intake should be limited to less than 1,500 mg a day.
• Regular exercise. Physical activity can help you decrease your blood pressure and keep your weight under control. Walking for at least 30 minutes a day, most days of the week can go a long way by decreasing your risk of many health conditions.
• Decrease stress as much as possible. Regular exercise and a lot of sleep can help you manage stress. Learning relaxation techniques, such as deep breathing or mindfulness, can decrease your blood pressure.
• Reduce your alcohol consumption. Alcohol has been shown to increase your blood pressure, even in healthy individuals. Healthy adults should practice moderate alcohol intakes, such as 2 alcoholic beverages a day for men, and 1 alcoholic beverage a day for women.
• Quit smoking. Tobacco has the ability to damage your blood vessel walls and increase plaque buildup in your arteries.
• Monitor your blood pressure at home and keep a daily log of your blood pressure measurements. Your daily log can be reviewed by your doctor to evaluate whether or not your blood pressure medications have been working effectively or not.

Which High Blood Pressure Medication Should I Take?:

Your blood pressure measurements, age, ethnicity, and overall health determine the type of medication your doctor may prescribe. Don’t stop taking your medication without talking with your doctor first. Otherwise, you may increase your risk of having a stroke or heart attack.

1. Thiazide Diuretics:

Commonly referred to as “water pills,” are a group of medications that help your kidneys remove sodium and water from your body.

• Chlorthalidone 12.5–25 mg daily    Order now
• Hydrochlorothiazide 12.5–50 mg daily    Order now

Common side effects include:

• Increased urination
• Hypokalemia (low potassium level - due to increased urination)
• Hypomagnesemia (low magnesium level)
• Hypercalcemia (high calcium levels - may cause weakened bones)
• Elevated lipids (high LDL and TG)
• Dizziness and lightheadedness
• Photosensitivity (sensitivity to sunlight)

2. Angiotensin-Converting Enzyme (ACE) Inhibitors:

A group of medications that block the conversion of angiotensin I to Angiotensin II, causing the blood vessels to relax by blocking the formation of a natural chemical, bradykinin, that narrows blood vessels.

• Benazepril (brand name: Lotensin) 5–40 mg daily    Order now
• Lisinopril (Prinivil, Zestril) 5–40 mg daily    Order now
• Enalapril (Vasotec) 5–20 mg daily or twice a day (BID)    Order now
• Ramipril (Altace) 2.5–20 mg daily    Order now
• Quinapril (Accupril) 5–40 mg daily    Order now

Common side effects include:

• Cough
• Dizziness
• Headache
• Rash

3. Angiotensin II Receptor Blockers (ARBs):

A group of medications relaxes blood vessels by blocking the production of a natural chemical, angiotensin II, a substance that narrows blood vessels and releases hormones such as aldosterone and norepinephrine, by inhibiting an enzyme called angiotensin-converting enzyme.

• Losartan (Cozaar) 25–100 mg daily    Order now
• Irbesartan (Avapro) 75–300 mg daily    Order now
• Valsartan (Diovan) 80–320 mg daily    Order now
• Olmesartan (Benicar) 10–40 mg daily    Order now

Common side effects include:

• Angioedema (swelling under your skin)
• Cough (less than ACE inhibitors)
• Dizziness
• Headache

4. Dihydropyridine (DHP) Calcium Channel Blockers (CCB):

A group of medications that inhibit calcium from entering your smooth muscle and cardiac calles, causing your blood vessel muscles to relax.

• Amlodipine (Norvasc) 2.5–10 mg daily    Order now
• Nifedipine ER (extended-release) (Adalat CC, Procardia XL) 30–90 mg daily

Common side effects include:

• Peripheral edema (swelling in your lower legs or hands)
• Flushing (redness of the face, neck, or chest)
• Headache
• Palpitation (fast heartbeat)

5. Beta-Blockers:

A group of medications that decrease the workload on your heart and widen your blood vessels, causing your heart to beat slower and with less force. Beta-blockers are not typically prescribed alone for HBP unless combined with other blood pressure medications, or if you have another health condition that requires a beta-blocker.

• Acebutolol 200–800 mg daily
• Atenolol (Tenormin) 25–100 mg daily    Order now
• Labetalol 100–200 mg BID    Order now

Common side effects include:

• Low heart rate
• Fatigue
• Dizziness
• Feeling sick
• Feeling tired

Pregnant Women

Pregnant women with chronic hypertension should receive medication treatment if their systolic blood pressure is greater than 160 mmHg or their diastolic blood pressure is greater than 105 mmHg. ACE inhibitors and ARBs have a black box warning (the strictest warnings for prescriptions) for fetal harm, and should not be taken by pregnant women.

The drug of choice for pregnant women that are hypertensive, according to the American College of Obstetricians and Gynecologists (ACOG), is methyldopa, which lowers blood pressure through the central nervous system and has the lowest risk of harming a fetus, labetalol, and nifedipine ER.

African Americans

African Americans have a higher risk of developing HBP at an earlier age and have the ability to be more severe. Some medications, such as those belonging to the drug class ACE inhibitors or ARBs, may not be as effective in lowering blood pressure in African Americans as they do in other ethnicities.

The drug classes that are recommended for African Americans with HBP are thiazide diuretics and CCB.