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{{short description| Long-term high blood pressure in the arteries}}
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{{About|arterial hypertension|other forms of hypertension}}
{{For|low blood pressure|Hypotension}}
{{Use dmy dates|date=April 2023}}
{{good article}}
{{Infobox medical condition (new)
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| image
| caption = Automated arm [[sphygmomanometer|blood pressure meter]] showing [[artery|arterial]] hypertension (shown by a [[systolic blood pressure]] 158 mmHg, [[diastolic blood pressure]] 99 mmHg and [[heart rate]] of 80 beats per minute)
| field = [[Cardiology]], [[Nephrology]]
| synonyms = Arterial hypertension, high blood pressure
| symptoms = None<ref name=CDC2024/>
| complications = [[Coronary artery disease]], [[stroke]], [[heart failure]], [[peripheral arterial disease]], [[vision loss]], [[chronic kidney disease]], [[dementia]]<ref name=Lack2015/><ref name=WHO2011/><ref name=Hernandorena2017/>
|
| duration =
| causes = Usually lifestyle and genetic factors<ref name=Lancet2015/>
| risks = [[Sleep deprivation|Lack of sleep]], [[Hypernatremia|excess salt]], [[overweight|excess body weight]], [[smoking]], [[Alcohol and cardiovascular disease|alcohol]]<ref name=CDC2024/><ref name=Lancet2015/>
| diagnosis = Resting blood pressure in adults<br> ≥ 130/80 mmHg<ref name=AHA2017/> or ≥ 140/90 mmHg<ref name="ESH2023"/>
| differential =
| prevention =
| treatment = Lifestyle changes, medications<ref name=NIH2015Tx/>
| medication =
| prognosis =
| frequency = 33% (all adults), 16% (diagnosed) <br> (globally, 2019)<ref name="WHOreport2023"/><ref name="NCD2021"/>
| deaths = 10.4 million; 19% of deaths <br> (globally, 2019)<ref name="WHOreport2023"/>
| alt =
}}
{{Human body weight}}
'''Hypertension''', also known as '''high blood pressure''', is a [[Chronic condition|long-term]] [[Disease|medical condition]] in which the [[blood pressure]] in the [[artery|arteries]] is persistently elevated.<ref name=Nai2014>{{cite book| vauthors = Naish J, Court DS |title=Medical sciences|date=2014|isbn=978-0-7020-5249-1|pages=562|publisher=Elsevier Health Sciences |edition=2|url={{Google books|K21_AwAAQBAJ|pages=PA562|keywords=|text=|plainurl=yes}}}}</ref> High blood pressure usually does not cause symptoms itself.<ref name=CDC2024>{{cite web|title=About High Blood Pressure |url=https://www.cdc.gov/high-blood-pressure/about/index.html|website=[[Centers for Disease Control and Prevention]] (CDC)|access-date=22 May 2024|date=15 May 2024|url-status=live|archive-url=https://web.archive.org/web/20240520060641/https://www.cdc.gov/high-blood-pressure/about/index.html|archive-date=20 May 2024}}</ref> It is, however, a major risk factor for [[stroke]], [[coronary artery disease]], [[heart failure]], [[atrial fibrillation]], [[peripheral arterial disease]], [[vision loss]], [[chronic kidney disease]], and [[dementia]].<ref name=Lack2015>{{cite journal | first1 = Daniel T. | last1 = Lackland | first2 = Michael A. | last2 = Weber | title = Global burden of cardiovascular disease and stroke: hypertension at the core | journal = The Canadian Journal of Cardiology | volume = 31 | issue = 5 | pages = 569–571 | date = May 2015 | pmid = 25795106 | doi = 10.1016/j.cjca.2015.01.009 }}</ref><ref name=WHO2011>{{cite book| vauthors = Mendis S, Puska P, Norrving B |title=Global atlas on cardiovascular disease prevention and control|date=2011|publisher=World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization|___location=Geneva|isbn=978-92-4-156437-3|pages=38|edition=1st|url=http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1|url-status=dead|archive-url=https://web.archive.org/web/20140817123106/http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1|archive-date=17 August 2014}}</ref><ref name="Hernandorena2017">{{cite journal | vauthors = Hernandorena I, Duron E, Vidal JS, Hanon O | title = Treatment options and considerations for hypertensive patients to prevent dementia | journal = Expert Opinion on Pharmacotherapy | volume = 18 | issue = 10 | pages = 989–1000 | date = July 2017 | pmid = 28532183 | doi = 10.1080/14656566.2017.1333599 | s2cid = 46601689 | type = Review }}</ref><ref name="Lau2017">{{cite journal | vauthors = Lau DH, Nattel S, Kalman JM, Sanders P | title = Modifiable Risk Factors and Atrial Fibrillation | journal = Circulation | volume = 136 | issue = 6 | pages = 583–596 | date = August 2017 | pmid = 28784826 | doi = 10.1161/CIRCULATIONAHA.116.023163 | type = Review | doi-access = free }}</ref> Hypertension is a major cause of premature death worldwide.<ref name=WHO2023>{{Cite web |title=Hypertension |url=https://www.who.int/news-room/fact-sheets/detail/hypertension |date = 16 March 2023 | access-date=2024-05-22 |publisher= [[World Health Organization]] (WHO) |language=en}}</ref>
High blood pressure is classified as [[essential hypertension|primary (essential) hypertension]] or [[secondary hypertension]].<ref name=Lancet2015/> About 90–95% of cases are primary, defined as high blood pressure due to non-specific lifestyle and [[Genetics|genetic]] factors.<ref name=Lancet2015/> Lifestyle factors that increase the risk include excess [[salt]] in the diet, [[overweight|excess body weight]], [[smoking]], [[physical inactivity]] and [[Alcohol (drug)|alcohol]] use.<ref name=CDC2024/><ref name=Lancet2015/> The remaining 5–10% of cases are categorized as secondary hypertension, defined as high blood pressure due to a clearly identifiable cause, such as [[chronic kidney disease]], [[renal artery stenosis|narrowing of the kidney arteries]], an [[endocrine disorder]], or the use of [[birth control pills]].<ref name=Lancet2015/>
Blood pressure is classified by two measurements, the [[Systole (medicine)|systolic]] (first number) and [[Diastole#Diastolic pressure|diastolic]] (second number) pressures.<ref name=CDC2024/> For most adults, normal blood pressure at rest is within the range of 100–140 [[Millimeter of mercury|millimeters mercury (mmHg)]] systolic and 60–90 mmHg diastolic.<ref name=AHA2017>{{cite journal | vauthors = Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT | title = 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: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines | journal = Hypertension | volume = 71 | issue = 6 | pages = e13–e115 | date = June 2018 | pmid = 29133356 | doi = 10.1161/HYP.0000000000000065 | doi-access = free }}</ref><ref name="ESH2023"/> For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg.<ref name=Lancet2015/><ref name=AHA2017/><ref name="ESH2023"/> Different numbers apply to children.<ref name=JNC8>{{cite journal | vauthors = James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E | title = 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8) | journal = JAMA | volume = 311 | issue = 5 | pages = 507–520 | date = February 2014 | pmid = 24352797 | doi = 10.1001/jama.2013.284427 | doi-access = free }}</ref> [[Ambulatory blood pressure monitoring]] over a 24-hour period appears more accurate than office-based [[blood pressure measurement]].<ref name=Lancet2015/><ref name=Nai2014/>
Lifestyle changes and medications can lower blood pressure and decrease the risk of health complications.<ref name=NIH2015Tx>{{cite web|title=How Is High Blood Pressure Treated?|url=http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/treatment|website=National Heart, Lung, and Blood Institute|access-date=6 March 2016|date=10 September 2015|url-status=dead|archive-url=https://web.archive.org/web/20160406073903/http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/treatment|archive-date=6 April 2016}}</ref> Lifestyle changes include [[weight loss]], [[Exercise|physical exercise]], decreased [[Health effects of salt|salt intake]], reducing [[Health effects of alcohol|alcohol intake]], and a [[healthy diet]].<ref name=Lancet2015/> If lifestyle changes are not sufficient, [[blood pressure medication]]s are used.<ref name=NIH2015Tx/> Up to three medications taken concurrently can control blood pressure in 90% of people.<ref name=Lancet2015>{{cite journal | vauthors = Poulter NR, Prabhakaran D, Caulfield M | title = Hypertension | journal = Lancet | volume = 386 | issue = 9995 | pages = 801–812 | date = August 2015 | pmid = 25832858 | doi = 10.1016/s0140-6736(14)61468-9 | s2cid = 208792897 }}</ref> The treatment of moderately high arterial blood pressure (defined as >160/100 mmHg) with medications is associated with an improved [[life expectancy]].<ref>{{cite journal | vauthors = Musini VM, Tejani AM, Bassett K, Puil L, Wright JM | title = Pharmacotherapy for hypertension in adults 60 years or older | journal = The Cochrane Database of Systematic Reviews | volume = 6 | pages = CD000028 | date = June 2019 | issue = 6 | pmid = 31167038 | pmc = 6550717 | doi = 10.1002/14651858.CD000028.pub3 }}</ref> The effect of treatment of blood pressure between 130/80 mmHg and 160/100 mmHg is less clear, with some reviews finding benefit<ref name=AHA2017/><ref>{{cite journal | vauthors = Sundström J, Arima H, Jackson R, Turnbull F, Rahimi K, Chalmers J, Woodward M, Neal B | title = Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis | journal = Annals of Internal Medicine | volume = 162 | issue = 3 | pages = 184–191 | date = February 2015 | pmid = 25531552 | doi = 10.7326/M14-0773 | s2cid = 46553658 }}</ref><ref>{{cite journal | vauthors = Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, Woodward M, MacMahon S, Turnbull F, Hillis GS, Chalmers J, Mant J, Salam A, Rahimi K, Perkovic V, Rodgers A | title = Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis | journal = Lancet | volume = 387 | issue = 10017 | pages = 435–443 | date = January 2016 | pmid = 26559744 | doi = 10.1016/S0140-6736(15)00805-3 | s2cid = 36805676 | url = http://www.med-sovet.pro/jour/article/view/1765 | access-date = 11 February 2019 | archive-url = https://web.archive.org/web/20190416234426/https://www.med-sovet.pro/jour/article/view/1765 | archive-date = 16 April 2019 | url-status = live | url-access = subscription }}</ref><ref>{{Cite journal |last1=Falk |first1=Jamie M. |last2=Froentjes |first2=Liesbeth |last3=Kirkwood |first3=Jessica Em |last4=Heran |first4=Balraj S. |last5=Kolber |first5=Michael R. |last6=Allan |first6=G. Michael |last7=Korownyk |first7=Christina S. |last8=Garrison |first8=Scott R. |date=2024-12-17 |title=Higher blood pressure targets for hypertension in older adults |journal=The Cochrane Database of Systematic Reviews |volume=2024 |issue=12 |pages=CD011575 |doi=10.1002/14651858.CD011575.pub3 |issn=1469-493X |pmc=11650777 |pmid=39688187|pmc-embargo-date=December 17, 2025 }}</ref>and others finding unclear benefit.<ref name=Diao2012>{{cite journal | vauthors = Diao D, Wright JM, Cundiff DK, Gueyffier F | title = Pharmacotherapy for mild hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 8 | issue = 8 | pages = CD006742 | date = August 2012 | pmid = 22895954 | doi = 10.1002/14651858.CD006742.pub2 | pmc = 8985074 | s2cid = 42363250 }}</ref><ref>{{cite journal | vauthors = Musini VM, Gueyffier F, Puil L, Salzwedel DM, Wright JM | title = Pharmacotherapy for hypertension in adults aged 18 to 59 years | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD008276 | date = August 2017 | issue = 8 | pmid = 28813123 | pmc = 6483466 | doi = 10.1002/14651858.CD008276.pub2 }}</ref> High blood pressure affects 33% of the population globally.<ref name="WHOreport2023"/> About half of all people with high blood pressure do not know that they have it.<ref name="WHOreport2023"/> In 2019, high blood pressure was believed to have been a factor in 19% of all deaths (10.4 million globally).<ref name="WHOreport2023"/>
[[File:En.Wikipedia-VideoWiki-Hypertension.webm|thumb|thumbtime=2:16|upright=1.3|Video summary ([[Wikipedia:VideoWiki/Hypertension|script]])]]
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==Signs and symptoms==
Hypertension is rarely accompanied by [[Signs and symptoms|symptoms]].<ref name=CDC2024/> Half of all people with hypertension are unaware that they have it.<ref name="WHOreport2023"/> Hypertension is usually identified as part of health [[Screening (medicine)|screening]] or when seeking healthcare for an unrelated problem.
Some people with high blood pressure report [[headache]]s, as well as [[lightheadedness]], [[vertigo]], [[tinnitus]] (buzzing or hissing in the ears), altered vision or [[Syncope (medicine)|fainting episodes]].<ref name=Harrison2005>{{cite book |vauthors=Fisher ND, Williams GH |veditors=Kasper DL, Braunwald E, Fauci AS |title=Harrison's Principles of Internal Medicine|url=https://archive.org/details/harrisonsprincip00kasp |url-access=limited |edition=16th |year=2005 |publisher=McGraw-Hill |___location=New York |isbn=978-0-07-139140-5 |pages=[https://archive.org/details/harrisonsprincip00kasp/page/n1491 1463]–1481 |chapter=Hypertensive vascular disease|display-editors=etal}}</ref> These symptoms, however, might be related to associated [[anxiety (mood)|anxiety]] rather than the high blood pressure itself.<ref name=Stress2012>{{cite journal | vauthors = Marshall IJ, Wolfe CD, McKevitt C | title = Lay perspectives on hypertension and drug adherence: systematic review of qualitative research | journal = The BMJ | volume = 345 | pages = e3953 | date = July 2012 | pmid = 22777025 | pmc = 3392078 | doi = 10.1136/bmj.e3953 }}</ref>
Long-standing untreated hypertension can cause organ damage with signs such as changes in the [[optic fundus]] seen by [[ophthalmoscopy]].<ref name=Wong2007>{{cite journal | vauthors = Wong TY, Wong T, Mitchell P | title = The eye in hypertension | journal = Lancet | volume = 369 | issue = 9559 | pages = 425–435 | date = February 2007 | pmid = 17276782 | doi = 10.1016/S0140-6736(07)60198-6 | s2cid = 28579025 }}</ref> The severity of [[hypertensive retinopathy]] correlates roughly with the duration or the severity of the hypertension.<ref name=Harrison2005/> Other hypertension-caused organ damage include [[chronic kidney disease]] and [[left ventricular hypertrophy|thickening of the heart muscle]].<ref name="WHOreport2023"/>
===Secondary hypertension===
{{Main|Secondary hypertension}}
Secondary hypertension is hypertension due to an identifiable cause and may result in certain specific additional signs and symptoms. For example, as well as causing high blood pressure, [[Cushing's syndrome]] frequently causes [[Abdominal obesity|truncal obesity]],<ref>{{Cite web |title=Truncal obesity (Concept Id: C4551560) – MedGen – NCBI |url=https://www.ncbi.nlm.nih.gov/medgen/1637490#Definition |access-date=2022-04-24 |website=ncbi.nlm.nih.gov |language=en}}</ref> [[glucose intolerance]], [[moon face]], a hump of fat behind the neck and shoulders (referred to as a buffalo hump), and purple abdominal [[stretch marks]].<ref name=ABC>{{cite book | vauthors = O'Brien E, Beevers DG, Lip GY |title=ABC of hypertension |publisher=BMJ Books |___location=London |year=2007 |isbn=978-1-4051-3061-5 }}</ref> [[Hyperthyroidism]] frequently causes weight loss with increased appetite, [[tachycardia|fast heart rate]], [[exophthalmos|bulging eyes]], and tremor. [[Renal artery stenosis]] may be associated with a localized abdominal [[bruit]] to the left or right of the midline, or in both locations. [[Coarctation of the aorta]] frequently causes a decreased blood pressure in the lower extremities relative to the arms, or delayed or absent [[femoral artery|femoral arterial pulses]]. [[Pheochromocytoma]] may cause abrupt episodes of hypertension accompanied by headache, [[palpitation]]s, [[Pallor|pale appearance]], and [[Diaphoresis|excessive sweating]].<ref name="ABC"/>
===Hypertensive crisis===
{{main|Hypertensive crisis}}
Severely elevated blood pressure (equal to or greater than a systolic pressure of 180 mmHg or a diastolic pressure of 120 mmHg) is referred to as a hypertensive crisis.<ref>{{Cite web | work = Center for Drug Evaluation and Research|date=2021-01-21 |title=High Blood Pressure – Understanding the Silent Killer |url=https://www.fda.gov/drugs/special-features/high-blood-pressure-understanding-silent-killer |publisher = U.S. Food and Drug Administration |language=en}}</ref> Hypertensive crisis is categorized as either [[hypertensive urgency]] or [[hypertensive emergency]], according to the absence or presence of end-organ damage, respectively.<ref>{{cite journal | vauthors = Rodriguez MA, Kumar SK, De Caro M | title = Hypertensive crisis | journal = Cardiology in Review | volume = 18 | issue = 2 | pages = 102–107 | date = 2010-04-01 | pmid = 20160537 | doi = 10.1097/CRD.0b013e3181c307b7 | s2cid = 34137590 }}</ref><ref>{{Cite web|title = Hypertensive Crisis|url = http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp|website = heart.org|access-date = 2015-07-25|url-status = live|archive-url = https://web.archive.org/web/20150725220209/http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp|archive-date = 25 July 2015}}</ref>
In hypertensive urgency, there is no evidence of end-organ damage resulting from the elevated blood pressure. In these cases, oral medications are used to lower blood pressure over 24 to 48 hours gradually.<ref name="Marik2007">{{cite journal | vauthors = Marik PE, Varon J | title = Hypertensive crises: challenges and management | journal = Chest | volume = 131 | issue = 6 | pages = 1949–1962 | date = June 2007 | pmid = 17565029 | doi = 10.1378/chest.06-2490 | url = http://chestjournal.chestpubs.org/content/131/6/1949.long | url-status = dead | archive-url = https://archive.today/20121204174126/http://chestjournal.chestpubs.org/content/131/6/1949.long | archive-date = 2012-12-04 | url-access = subscription }}</ref>
In a hypertensive emergency, there is evidence of direct damage to one or more organs.<ref name=JNC7/><ref name="Perez">{{cite journal | vauthors = Perez MI, Musini VM | title = Pharmacological interventions for hypertensive emergencies | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD003653 | date = January 2008 | volume = 2008 | pmid = 18254026 | doi = 10.1002/14651858.CD003653.pub3 | pmc = 6991936 }}</ref> The most affected organs include the brain, kidney, heart, and lungs, producing symptoms that may include [[confusion]], drowsiness, chest pain, and breathlessness.<ref name="Marik2007"/> In a hypertensive emergency, the blood pressure must be reduced more rapidly to stop ongoing organ damage;<ref name="Marik2007"/> however, there is a lack of [[randomized controlled trial]] evidence for this approach.<ref name=Perez/>
===Pregnancy===
{{main|Gestational hypertension|Pre-eclampsia}}
Hypertension occurs in approximately 8–10% of pregnancies.<ref name="ABC"/> Two blood pressure measurements six hours apart of greater than 140/90 mmHg are diagnostic of hypertension in pregnancy.<ref name="Harrison2011">{{cite book|title=Harrison's principles of internal medicine.|publisher=McGraw-Hill|___location=New York|isbn=978-0-07-174889-6|year=2011|pages=55–61|edition=18th}}</ref> High blood pressure in pregnancy can be classified as pre-existing hypertension, [[gestational hypertension]], or [[pre-eclampsia]].<ref name="uptodate.com">{{Cite web|title = Management of hypertension in pregnant and postpartum women|url = http://www.uptodate.com/contents/management-of-hypertension-in-pregnant-and-postpartum-women|website = uptodate.com|access-date = 2015-07-30|url-status = live|archive-url = https://web.archive.org/web/20160304070333/http://www.uptodate.com/contents/management-of-hypertension-in-pregnant-and-postpartum-women|archive-date = 4 March 2016}}</ref> Women who have chronic hypertension before their pregnancy are at increased risk of complications such as [[Preterm birth|premature birth]], [[Small for gestational age|low birthweight]] or [[stillbirth]].<ref>{{cite journal | vauthors = Al Khalaf SY, O'Reilly ÉJ, Barrett PM, B Leite DF, Pawley LC, McCarthy FP, Khashan AS | title = Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis | journal = Journal of the American Heart Association | volume = 10 | issue = 9 | article-number = e018494 | date = May 2021 | pmid = 33870708 | pmc = 8200761 | doi = 10.1161/JAHA.120.018494 }}</ref> Women who have high blood pressure and had complications in their pregnancy have three times the risk of developing [[cardiovascular disease]] compared to women with normal blood pressure who had no complications in pregnancy.<ref>{{Cite journal |date=2023-11-21 |title=Pregnancy complications increase the risk of heart attacks and stroke in women with high blood pressure |url=https://evidence.nihr.ac.uk/alert/pregnancy-complications-increase-the-risk-of-heart-attacks-and-stroke-in-women-with-high-blood-pressure/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_60660|s2cid=265356623 |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Al Khalaf S, Chappell LC, Khashan AS, McCarthy FP, O'Reilly ÉJ | title = Association Between Chronic Hypertension and the Risk of 12 Cardiovascular Diseases Among Parous Women: The Role of Adverse Pregnancy Outcomes | journal = Hypertension | volume = 80 | issue = 7 | pages = 1427–1438 | date = July 2023 | pmid = 37170819 | doi = 10.1161/HYPERTENSIONAHA.122.20628 | doi-access = free }}</ref>
Pre-eclampsia is a serious condition in the second half of pregnancy and [[puerperium|following delivery]] characterised by increased blood pressure and the presence of [[proteinuria|protein in the urine]].<ref name="ABC"/> It occurs in about 5% of pregnancies and is responsible for approximately 16% of all [[maternal death]]s globally.<ref name="ABC"/> Pre-eclampsia also doubles the risk of [[perinatal mortality|death of the baby around the time of birth]].<ref name="ABC"/> Usually, there are no symptoms in pre-eclampsia, and it is detected by routine screening. When symptoms of pre-eclampsia occur, the most common are headache, visual disturbance (often "flashing lights"), vomiting, pain over the stomach, and [[edema|swelling]]. Pre-eclampsia can occasionally progress to a life-threatening condition called [[eclampsia]], which is a [[hypertensive emergency]] and has several serious complications including [[blindness|vision loss]], [[cerebral edema|brain swelling]], [[tonic-clonic seizures|seizures]], [[kidney failure]], [[pulmonary edema]], and [[disseminated intravascular coagulation]] (a blood clotting disorder).<ref name="ABC"/><ref name="urlHypertension and Pregnancy: eMedicine Obstetrics and Gynecology">{{cite web |url=http://emedicine.medscape.com/article/261435-overview |title=Hypertension and Pregnancy | vauthors = Gibson P |date=30 July 2009 |work=eMedicine Obstetrics and Gynecology |publisher=Medscape |access-date=16 June 2009 |url-status=live |archive-url=https://web.archive.org/web/20090724065747/http://emedicine.medscape.com/article/261435-overview |archive-date=24 July 2009 }}</ref>
In contrast, [[gestational hypertension]] is defined as new-onset hypertension during pregnancy without protein in the urine.<ref name="uptodate.com"/>
There have been significant findings on how exercising can help reduce the effects of hypertension just after one bout of exercise. Exercising can help reduce hypertension as well as pre-eclampsia and eclampsia.
The acute physiological responses include an increase in cardiac output (CO) of the individual (increased heart rate and stroke volume). This increase in CO can inadvertently maintain the amount of blood going into the muscles, improving the functionality of the muscle later. Exercising can also improve systolic and diastolic blood pressure, making it easier for blood to pump to the body. Through regular bouts of physical activity, blood pressure can be reduced and lower the incidence of hypertension.<ref>{{Cite journal |last1=Ruivo |first1=Jorge A. |last2=Alcântara |first2=Paula |date=February 2012 |title=Hipertensão arterial e exercício físico |journal=Revista Portuguesa de Cardiologia |language=pt |volume=31 |issue=2 |pages=151–158 |doi=10.1016/j.repc.2011.12.012|pmid=22237005 |doi-access=free }}</ref>
Aerobic exercise has been shown to regulate blood pressure more effectively than resistance training. It is recommended to see the effects of exercising, that a person should aim for 5–7 days/ week of aerobic exercise. This type of exercise should have an intensity of light to moderate, utilizing ~85% of max heart rate (220-age). Aerobic has shown a decrease in SBP by 5–15 mmHg, versus resistance training, showing a decrease of only 3–5 mmHg. Aerobic exercises such as jogging, rowing, dancing, or hiking can decrease SBP the most. The decrease in SBP can regulate the effect of hypertension, ensuring the baby will not be harmed. Resistance training takes a toll on the cardiovascular system in untrained individuals, leading to a reluctance in the prescription of resistance training for hypertensive reduction purposes.<ref>{{Cite report |url=http://www.scivee.tv/node/9522 |archive-url=https://web.archive.org/web/20100515142447/http://www.scivee.tv/node/9522 |url-status=dead |archive-date=15 May 2010 |title=ResearchGATE |date=2009-01-13 |publisher=SciVee |doi=10.4016/9522.01 |doi-broken-date=22 August 2025 |language=en|url-access=subscription }}</ref><ref>{{Cite journal |last1=Kokkinos |first1=Peter F. |last2=Narayan |first2=Puneet |last3=Papademetriou |first3=Vasilios |date=2001-08-01 |title=Exercise as Hypertension Therapy |url=https://www.sciencedirect.com/science/article/abs/pii/S0733865105702320 |journal=Cardiology Clinics |volume=19 |issue=3 |pages=507–516 |doi=10.1016/S0733-8651(05)70232-0 |pmid=11570120 |issn=0733-8651|url-access=subscription }}</ref>
===Children===
[[Failure to thrive]], [[seizures]], [[irritability]], [[lethargy|lack of energy]], and [[Infant respiratory distress syndrome|difficulty in breathing]]<ref name="urlHypertension: eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine">{{cite web |url=http://emedicine.medscape.com/article/889877-overview |title=Hypertension | vauthors = Rodriguez-Cruz E, Ettinger LM |date=6 April 2010 |work=eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine |publisher=Medscape |access-date=16 June 2009 |url-status=live |archive-url=https://web.archive.org/web/20090815113248/http://emedicine.medscape.com/article/889877-overview |archive-date=15 August 2009 }}</ref> can be associated with hypertension in newborns and young infants. In older infants and children, hypertension can cause headache, unexplained irritability, [[fatigue (medical)|fatigue]], failure to thrive, [[blurred vision]], [[epistaxis|nosebleeds]], and [[Bell's palsy|facial paralysis]].<ref name="urlHypertension: eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine"/><ref name=Dionne/>
==Causes==
===Primary hypertension===
{{Main|Essential hypertension}}
Primary (also termed essential) hypertension results from a complex interaction of [[Gene|genes]] and environmental factors. More than 2000 common genetic variants with small effects on blood pressure have been identified in association with high blood pressure,<ref>{{Cite journal |last1=Keaton |first1=Jacob M. |last2=Kamali |first2=Zoha |last3=Xie |first3=Tian |last4=Vaez |first4=Ahmad |last5=Williams |first5=Ariel |last6=Goleva |first6=Slavina B. |last7=Ani |first7=Alireza |last8=Evangelou |first8=Evangelos |last9=Hellwege |first9=Jacklyn N. |last10=Yengo |first10=Loic |last11=Young |first11=William J. |last12=Traylor |first12=Matthew |last13=Giri |first13=Ayush |last14=Zheng |first14=Zhili |last15=Zeng |first15=Jian |date=May 2024 |title=Genome-wide analysis in over 1 million individuals of European ancestry yields improved polygenic risk scores for blood pressure traits |journal=Nature Genetics |language=en |volume=56 |issue=5 |pages=778–791 |doi=10.1038/s41588-024-01714-w |issn=1061-4036 |pmc=11096100 |pmid=38689001}}</ref> as well as some rare genetic variants with large effects on blood pressure.<ref>{{cite journal | vauthors = Lifton RP, Gharavi AG, Geller DS | title = Molecular mechanisms of human hypertension | journal = Cell | volume = 104 | issue = 4 | pages = 545–556 | date = February 2001 | pmid = 11239411 | doi = 10.1016/S0092-8674(01)00241-0 | doi-access = free }}</ref> There is also evidence that [[DNA methylation]] at multiple nearby [[CpG site]]s may link some sequence variation to blood pressure, possibly via effects on vascular or renal function.<ref name="Nor2016">{{cite journal | vauthors = Kato N, Loh M, Takeuchi F, Verweij N, Wang X, Zhang W, etal | title = Trans-ancestry genome-wide association study identifies 12 genetic loci influencing blood pressure and implicates a role for DNA methylation | journal = Nature Genetics | volume = 47 | issue = 11 | pages = 1282–1293 | date = November 2015 | pmid = 26390057 | pmc = 4719169 | doi = 10.1038/ng.3405 }}</ref>
Blood pressure rises with [[aging]] in societies with a [[Western pattern diet|western diet]] and lifestyle,<ref>{{Cite journal| vauthors = Carrera-Bastos P, Fontes-Villalba M, O'Keefe JH, Lindeberg S, Cordain L |date=2011-03-09|title=The western diet and lifestyle and diseases of civilization|url=https://www.dovepress.com/the-western-diet-and-lifestyle-and-diseases-of-civilization-peer-reviewed-article-RRCC|access-date=2021-02-09|journal=Research Reports in Clinical Cardiology|volume=2|pages=15–35|doi=10.2147/RRCC.S16919|s2cid=3231706 |language=English|doi-access=free}}</ref> and the risk of becoming hypertensive in later life is substantial in most such societies.<ref>{{cite journal | vauthors = Vasan RS, [[Alexa Beiser|Beiser A]], Seshadri S, Larson MG, Kannel WB, D'Agostino RB, Levy D | title = Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study | journal = JAMA | volume = 287 | issue = 8 | pages = 1003–1010 | date = February 2002 | pmid = 11866648 | doi = 10.1001/jama.287.8.1003 | doi-access = free }}</ref> Several environmental or lifestyle factors influence blood pressure. Reducing dietary salt intake lowers blood pressure;<ref>{{Cite journal |last1=Filippini |first1=Tommaso |last2=Malavolti |first2=Marcella |last3=Whelton |first3=Paul K. |last4=Naska |first4=Androniki |last5=Orsini |first5=Nicola |last6=Vinceti |first6=Marco |date=2021-04-20 |title=Blood Pressure Effects of Sodium Reduction: Dose–Response Meta-Analysis of Experimental Studies |journal=Circulation |language=en |volume=143 |issue=16 |pages=1542–1567 |doi=10.1161/CIRCULATIONAHA.120.050371 |issn=0009-7322 |pmc=8055199 |pmid=33586450}}</ref> as does weight loss,<ref>{{Cite journal |last1=Hall |first1=Michael E. |last2=Cohen |first2=Jordana B. |last3=Ard |first3=Jamy D. |last4=Egan |first4=Brent M. |last5=Hall |first5=John E. |last6=Lavie |first6=Carl J. |last7=Ma |first7=Jun |last8=Ndumele |first8=Chiadi E. |last9=Schauer |first9=Philip R. |last10=Shimbo |first10=Daichi |last11=on behalf of the American Heart Association Council on Hypertension; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; and Stroke Council |date=November 2021 |title=Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association |url=https://www.ahajournals.org/doi/10.1161/HYP.0000000000000202 |journal=Hypertension |language=en |volume=78 |issue=5 |pages=e38–e50 |doi=10.1161/HYP.0000000000000202 |pmid=34538096 |issn=0194-911X|url-access=subscription }}</ref> exercise training,<ref>{{Cite journal |last1=Edwards |first1=Jamie J. |last2=Deenmamode |first2=Algis H. P. |last3=Griffiths |first3=Megan |last4=Arnold |first4=Oliver |last5=Cooper |first5=Nicola J. |last6=Wiles |first6=Jonathan D. |last7=O'Driscoll |first7=Jamie M. |date=October 2023 |title=Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials |journal=British Journal of Sports Medicine |volume=57 |issue=20 |pages=1317–1326 |doi=10.1136/bjsports-2022-106503 |issn=1473-0480 |pmid=37491419}}</ref> vegetarian diets,<ref>{{Cite journal |last1=Lee |first1=Kai Wei |last2=Loh |first2=Hong Chuan |last3=Ching |first3=Siew Mooi |last4=Devaraj |first4=Navin Kumar |last5=Hoo |first5=Fan Kee |date=2020-05-29 |title=Effects of Vegetarian Diets on Blood Pressure Lowering: A Systematic Review with Meta-Analysis and Trial Sequential Analysis |journal=Nutrients |language=en |volume=12 |issue=6 |pages=1604 |doi=10.3390/nu12061604 |doi-access=free |pmc=7352826 |pmid=32486102}}</ref> increased dietary potassium intake<ref>{{Cite journal |last1=Sriperumbuduri |first1=Sriram |last2=Welling |first2=Paul |last3=Ruzicka |first3=Marcel |last4=Hundemer |first4=Gregory L |last5=Hiremath |first5=Swapnil |date=2023-09-29 |title=Potassium and Hypertension: A State-of-the-Art Review |url=https://academic.oup.com/ajh/article-abstract/37/2/91/7286227?redirectedFrom=fulltext |journal=American Journal of Hypertension |volume=37 |issue=2 |pages=91–100 |doi=10.1093/ajh/hpad094 |pmid=37772757 |issn=0895-7061|url-access=subscription }}</ref> and high dietary calcium supplementation.<ref>{{Cite journal |last1=Cormick |first1=Gabriela |last2=Ciapponi |first2=Agustín |last3=Cafferata |first3=María Luisa |last4=Cormick |first4=María Sol |last5=Belizán |first5=José M |date=2022-01-11 |editor-last=Cochrane Hypertension Group |title=Calcium supplementation for prevention of primary hypertension |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=1 |pages=CD010037 |doi=10.1002/14651858.CD010037.pub4 |pmc=8748265 |pmid=35014026}}</ref> Increasing alcohol intake is associated with higher blood pressure,<ref>{{Cite journal |last1=Di Federico |first1=Silvia |last2=Filippini |first2=Tommaso |last3=Whelton |first3=Paul K. |last4=Cecchini |first4=Marta |last5=Iamandii |first5=Inga |last6=Boriani |first6=Giuseppe |last7=Vinceti |first7=Marco |date=October 2023 |title=Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies |journal=Hypertension |language=en |volume=80 |issue=10 |pages=1961–1969 |doi=10.1161/HYPERTENSIONAHA.123.21224 |issn=0194-911X |pmc=10510850 |pmid=37522179}}</ref> but the possible roles of other factors such as caffeine consumption,<ref>{{cite journal | vauthors = Mesas AE, Leon-Muñoz LM, Rodriguez-Artalejo F, Lopez-Garcia E | title = The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis | journal = The American Journal of Clinical Nutrition | volume = 94 | issue = 4 | pages = 1113–1126 | date = October 2011 | pmid = 21880846 | doi = 10.3945/ajcn.111.016667 | doi-access = free }}</ref> and [[vitamin D deficiency]]<ref>{{cite journal | vauthors = Vaidya A, Forman JP | title = Vitamin D and hypertension: current evidence and future directions | journal = Hypertension | volume = 56 | issue = 5 | pages = 774–779 | date = November 2010 | pmid = 20937970 | doi = 10.1161/HYPERTENSIONAHA.109.140160 | doi-access = free }}</ref> are less clear. Average blood pressure is higher in the winter than in the summer.<ref>{{Cite journal |last1=Narita |first1=Keisuke |last2=Hoshide |first2=Satoshi |last3=Kario |first3=Kazuomi |date=November 2021 |title=Seasonal variation in blood pressure: current evidence and recommendations for hypertension management |url=https://www.nature.com/articles/s41440-021-00732-z |journal=Hypertension Research |language=en |volume=44 |issue=11 |pages=1363–1372 |doi=10.1038/s41440-021-00732-z |pmid=34489592 |issn=1348-4214|url-access=subscription |doi-access=free }}</ref>
[[depression (mood)|Depression]] is associated with hypertension<ref>{{cite journal | vauthors = Meng L, Chen D, Yang Y, Zheng Y, Hui R | title = Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies | journal = Journal of Hypertension | volume = 30 | issue = 5 | pages = 842–851 | date = May 2012 | pmid = 22343537 | doi = 10.1097/hjh.0b013e32835080b7 | s2cid = 32187480 }}</ref> and [[loneliness]] is also a risk factor.<ref name="Cacioppo, J 2010 p218-227">{{cite journal | vauthors = Hawkley LC, Cacioppo JT | title = Loneliness matters: a theoretical and empirical review of consequences and mechanisms | journal = Annals of Behavioral Medicine | volume = 40 | issue = 2 | pages = 218–227 | date = October 2010 | pmid = 20652462 | pmc = 3874845 | doi = 10.1007/s12160-010-9210-8 }}</ref> [[Periodontal disease]] is also associated with high blood pressure.<ref>{{cite journal | vauthors = Muñoz Aguilera E, Suvan J, Buti J, Czesnikiewicz-Guzik M, Barbosa Ribeiro A, Orlandi M, Guzik TJ, Hingorani AD, Nart J, D'Aiuto F | display-authors = 6 | title = Periodontitis is associated with hypertension: a systematic review and meta-analysis | journal = Cardiovascular Research | volume = 116 | issue = 1 | pages = 28–39 | date = January 2020 | pmid = 31549149 | doi = 10.1093/cvr/cvz201 | doi-access = free | veditors = Lembo G }}</ref> [[Arsenic]] exposure through drinking water is associated with elevated blood pressure.<ref>{{cite journal | vauthors = Abhyankar LN, Jones MR, Guallar E, Navas-Acien A | title = Arsenic exposure and hypertension: a systematic review | journal = Environmental Health Perspectives | volume = 120 | issue = 4 | pages = 494–500 | date = April 2012 | pmid = 22138666 | pmc = 3339454 | doi = 10.1289/ehp.1103988 | bibcode = 2012EnvHP.120..494A }}</ref> [[Air pollution]] is associated with hypertension.<ref>{{cite journal | vauthors = Yang BY, Qian Z, Howard SW, Vaughn MG, Fan SJ, Liu KK, Dong GH | title = Global association between ambient air pollution and blood pressure: A systematic review and meta-analysis | journal = Environmental Pollution | volume = 235 | pages = 576–588 | date = April 2018 | pmid = 29331891 | doi = 10.1016/j.envpol.2018.01.001 | bibcode = 2018EPoll.235..576Y }}</ref> Whether these associations are causal is unknown. [[Gout]] and elevated blood [[hyperuricemia|uric acid]] are associated with hypertension<ref>{{Cite journal |last1=Sandoval-Plata |first1=Gabriela |last2=Nakafero |first2=Georgina |last3=Chakravorty |first3=Mithun |last4=Morgan |first4=Kevin |last5=Abhishek |first5=Abhishek |date=2021-07-01 |title=Association between serum urate, gout and comorbidities: a case–control study using data from the UK Biobank |url=https://academic.oup.com/rheumatology/article/60/7/3243/6032841 |journal=Rheumatology |language=en |volume=60 |issue=7 |pages=3243–3251 |doi=10.1093/rheumatology/keaa773 |pmid=33313843 |issn=1462-0324|url-access=subscription }}</ref> and evidence from genetic ([[Mendelian randomization|Mendelian Randomization]]) studies and clinical trials indicate this relationship is likely to be causal.<ref>{{Cite journal |last1=Gill |first1=Dipender |last2=Cameron |first2=Alan C. |last3=Burgess |first3=Stephen |last4=Li |first4=Xue |last5=Doherty |first5=Daniel J. |last6=Karhunen |first6=Ville |last7=Abdul-Rahim |first7=Azmil H. |last8=Taylor-Rowan |first8=Martin |last9=Zuber |first9=Verena |last10=Tsao |first10=Philip S. |last11=Klarin |first11=Derek |last12=VA Million Veteran Program |last13=Evangelou |first13=Evangelos |last14=Elliott |first14=Paul |last15=Damrauer |first15=Scott M. |date=February 2021 |title=Urate, Blood Pressure, and Cardiovascular Disease: Evidence From Mendelian Randomization and Meta-Analysis of Clinical Trials |journal=Hypertension |language=en |volume=77 |issue=2 |pages=383–392 |doi=10.1161/HYPERTENSIONAHA.120.16547 |issn=0194-911X |pmc=7803439 |pmid=33356394}}</ref> [[Insulin resistance]], which is common in obesity and is a component of [[metabolic syndrome|syndrome X]] (or [[metabolic syndrome]]), can cause hyperuricemia and gout<ref>{{Cite journal |last1=McCormick |first1=Natalie |last2=O'Connor |first2=Mark J. |last3=Yokose |first3=Chio |last4=Merriman |first4=Tony R. |last5=Mount |first5=David B. |last6=Leong |first6=Aaron |last7=Choi |first7=Hyon K. |date=November 2021 |title=Assessing the Causal Relationships Between Insulin Resistance and Hyperuricemia and Gout Using Bidirectional Mendelian Randomization |journal=Arthritis & Rheumatology |volume=73 |issue=11 |pages=2096–2104 |doi=10.1002/art.41779 |issn=2326-5205 |pmc=8568618 |pmid=33982892}}</ref> and is also associated with elevated blood pressure.<ref>{{Cite journal |last1=Quesada |first1=Odayme |last2=Claggett |first2=Brian |last3=Rodriguez |first3=Fatima |last4=Cai |first4=Jianwen |last5=Moncrieft |first5=Ashley E. |last6=Garcia |first6=Karin |last7=Del Rios Rivera |first7=Marina |last8=Hanna |first8=David B. |last9=Daviglus |first9=Martha L. |last10=Talavera |first10=Gregory A. |last11=Bairey Merz |first11=C. Noel |last12=Solomon |first12=Scott D. |last13=Cheng |first13=Susan |last14=Bello |first14=Natalie A. |date=September 2021 |title=Associations of Insulin Resistance With Systolic and Diastolic Blood Pressure: A Study From the HCHS/SOL |journal=Hypertension |language=en |volume=78 |issue=3 |pages=716–725 |doi=10.1161/HYPERTENSIONAHA.120.16905 |issn=0194-911X |pmc=8650976 |pmid=34379440}}</ref>
Events in early life, such as [[low birth weight]], [[Smoking and pregnancy|maternal smoking]], and lack of [[breastfeeding]] may be risk factors for adult essential hypertension, although the strength of the relationships is weak and the mechanisms linking these exposures to adult hypertension remain unclear.<ref name="Lawlor 2005">{{cite journal | vauthors = Lawlor DA, Smith GD | title = Early life determinants of adult blood pressure | journal = Current Opinion in Nephrology and Hypertension | volume = 14 | issue = 3 | pages = 259–264 | date = May 2005 | pmid = 15821420 | doi = 10.1097/01.mnh.0000165893.13620.2b | s2cid = 10646150 }}</ref>
{{Main|Secondary hypertension}}
Secondary hypertension results from an identifiable cause. Kidney disease is the most common secondary cause of hypertension.<ref name="ABC"/> Hypertension can also be caused by endocrine conditions, such as [[Cushing's syndrome]], [[hyperthyroidism]], [[hypothyroidism]], [[acromegaly]], [[Conn's syndrome]] or [[hyperaldosteronism]], [[renal artery stenosis]] (from [[atherosclerosis]] or [[fibromuscular dysplasia]]), [[hyperparathyroidism]], and [[pheochromocytoma]].<ref name="ABC"/><ref>{{cite book|vauthors=Dluhy RG, Williams GH|title=Williams textbook of endocrinology|year=1998|publisher=W.B. Saunders|___location=Philadelphia; Montreal|isbn=978-0-7216-6152-0|edition=9th|chapter=Endocrine hypertension|veditors=Wilson JD, Foster DW, Kronenberg HM|pages=729–749|chapter-url-access=registration|chapter-url=https://archive.org/details/williamstextbook00wils}}</ref> Other causes of secondary hypertension include [[obesity]], [[sleep apnea]], [[pregnancy]], [[coarctation of the aorta]], excessive eating of [[liquorice]], excessive drinking of alcohol, certain prescription medicines, herbal remedies, and [[stimulants]] such as [[cocaine]] and [[methamphetamine]].<ref name="ABC"/><ref>{{cite journal | vauthors = Grossman E, Messerli FH | title = Drug-induced hypertension: an unappreciated cause of secondary hypertension | journal = The American Journal of Medicine | volume = 125 | issue = 1 | pages = 14–22 | date = January 2012 | pmid = 22195528 | doi = 10.1016/j.amjmed.2011.05.024 }}</ref>
A 2018 review found that any alcohol increased blood pressure in males, while over one or two drinks increased the risk in females.<ref>{{cite journal | vauthors = Roerecke M, Tobe SW, Kaczorowski J, Bacon SL, Vafaei A, Hasan OS, Krishnan RJ, Raifu AO, Rehm J | title = Sex-Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies | journal = Journal of the American Heart Association | volume = 7 | issue = 13 | article-number = e008202 | date = June 2018 | pmid = 29950485 | pmc = 6064910 | doi = 10.1161/JAHA.117.008202 }}</ref>
==Pathophysiology==
{{Main|Pathophysiology of hypertension}}
[[File:Mean arterial pressure.png|thumb|upright=1.4|Determinants of mean arterial pressure]]
[[File:Blausen 0486 HighBloodPressure 01.png|thumb|upright=1.4|Illustration depicting the effects of high blood pressure]]
In most people with established [[essential (primary) hypertension|essential hypertension]], increased resistance to blood flow ([[total peripheral resistance]]) accounts for the high pressure while [[cardiac output]] remains normal.<ref>{{cite journal | vauthors = Conway J | title = Hemodynamic aspects of essential hypertension in humans | journal = Physiological Reviews | volume = 64 | issue = 2 | pages = 617–660 | date = April 1984 | pmid = 6369352 | doi = 10.1152/physrev.1984.64.2.617 }}</ref> There is evidence that some younger people with [[prehypertension]] or 'borderline hypertension' have high cardiac output, an elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline hypertension.<ref name = Palatini>{{cite journal | vauthors = Palatini P, Julius S | title = The role of cardiac autonomic function in hypertension and cardiovascular disease | journal = Current Hypertension Reports | volume = 11 | issue = 3 | pages = 199–205 | date = June 2009 | pmid = 19442329 | doi = 10.1007/s11906-009-0035-4 | s2cid = 11320300 }}</ref> These individuals may develop the typical features of established essential hypertension in later life as their cardiac output falls and peripheral resistance rises with age.<ref name = Palatini /> Whether this pattern is typical of all people who ultimately develop hypertension is disputed.<ref>{{cite journal | vauthors = Andersson OK, Lingman M, Himmelmann A, Sivertsson R, Widgren BR | title = Prediction of future hypertension by casual blood pressure or invasive hemodynamics? A 30-year follow-up study | journal = Blood Pressure | volume = 13 | issue = 6 | pages = 350–354 | year = 2004 | pmid = 15771219 | doi = 10.1080/08037050410004819 | s2cid = 28992820 }}</ref> The increased peripheral resistance in established hypertension is mainly attributable to structural narrowing of small arteries and [[arteriole]]s,<ref>{{cite journal | vauthors = Folkow B | title = Physiological aspects of primary hypertension | journal = Physiological Reviews | volume = 62 | issue = 2 | pages = 347–504 | date = April 1982 | pmid = 6461865 | doi = 10.1152/physrev.1982.62.2.347 }}</ref> although a reduction in the number or density of capillaries may also contribute.<ref>{{cite journal | vauthors = Struijker Boudier HA, le Noble JL, Messing MW, Huijberts MS, le Noble FA, van Essen H | title = The microcirculation and hypertension | journal = Journal of Hypertension Supplement | volume = 10 | issue = 7 | pages = S147–156 | date = December 1992 | pmid = 1291649 | doi = 10.1097/00004872-199212000-00016 }}</ref>
It is unclear whether or not [[vasoconstriction]] of arteriolar blood vessels plays a role in hypertension.<ref>{{cite journal | vauthors = Schiffrin EL | title = Reactivity of small blood vessels in hypertension: relation with structural changes. State of the art lecture | journal = Hypertension | volume = 19 | issue = 2 Suppl | pages = II1-9 | date = February 1992 | pmid = 1735561 | doi = 10.1161/01.HYP.19.2_Suppl.II1-a | doi-access = free }}</ref> Hypertension is also associated with decreased peripheral [[Compliance (physiology)|venous compliance]],<ref>{{cite journal | vauthors = Safar ME, London GM | title = Arterial and venous compliance in sustained essential hypertension | journal = Hypertension | volume = 10 | issue = 2 | pages = 133–139 | date = August 1987 | pmid = 3301662 | doi = 10.1161/01.HYP.10.2.133 | doi-access = free }}</ref> which may increase [[venous return]], increase cardiac [[Preload (cardiology)|preload]] and, ultimately, cause [[diastolic dysfunction]]. For patients having hypertension, higher [[heart rate variability]] (HRV) is a risk factor for [[atrial fibrillation]].<ref name="pmid35260686">{{cite journal | vauthors = Kim SH, Lim KR, Chun KJ | title=Higher heart rate variability as a predictor of atrial fibrillation in patients with hypertensione | journal= [[Scientific Reports]] | volume=12 | issue=1 | article-number=3702 | year=2022 | doi= 10.1038/s41598-022-07783-3 | pmc=8904557 | pmid=35260686 | bibcode=2022NatSR..12.3702K }}</ref>
[[Pulse pressure]] (the difference between systolic and diastolic blood pressure) is frequently increased in older people with hypertension.<ref>{{cite journal | vauthors = Steppan J, Barodka V, Berkowitz DE, Nyhan D | title = Vascular stiffness and increased pulse pressure in the aging cardiovascular system | journal = Cardiology Research and Practice | volume = 2011 | pages = 263585 | date = 2011-08-02 | pmid = 21845218 | pmc = 3154449 | doi = 10.4061/2011/263585 | doi-access = free }}</ref> This can mean that systolic pressure is abnormally high, but diastolic pressure may be normal or low, a condition termed [[isolated systolic hypertension]].<ref>{{cite journal | vauthors = Chobanian AV | title = Clinical practice. Isolated systolic hypertension in the elderly | journal = The New England Journal of Medicine | volume = 357 | issue = 8 | pages = 789–796 | date = August 2007 | pmid = 17715411 | doi = 10.1056/NEJMcp071137 | s2cid = 42515260 }}</ref> The high pulse pressure in elderly people with hypertension or isolated systolic hypertension is explained by increased [[arterial stiffness]], which typically accompanies aging and may be exacerbated by high blood pressure.<ref>{{cite journal | vauthors = Zieman SJ, Melenovsky V, Kass DA | title = Mechanisms, pathophysiology, and therapy of arterial stiffness | journal = Arteriosclerosis, Thrombosis, and Vascular Biology | volume = 25 | issue = 5 | pages = 932–943 | date = May 2005 | pmid = 15731494 | doi = 10.1161/01.ATV.0000160548.78317.29 | doi-access = free }}</ref>
Many mechanisms have been proposed to account for the rise in peripheral resistance in hypertension. Most evidence implicates either disturbances in the kidneys' salt and water handling (particularly abnormalities in the intrarenal [[renin–angiotensin system]])<ref>{{cite journal | vauthors = Navar LG | title = Counterpoint: Activation of the intrarenal renin-angiotensin system is the dominant contributor to systemic hypertension | journal = Journal of Applied Physiology | volume = 109 | issue = 6 | pages = 1998–2000; discussion 2015 | date = December 2010 | pmid = 21148349 | pmc = 3006411 | doi = 10.1152/japplphysiol.00182.2010a }}</ref> or abnormalities of the [[sympathetic nervous system]].<ref>{{cite journal | vauthors = Esler M, Lambert E, Schlaich M | title = Point: Chronic activation of the sympathetic nervous system is the dominant contributor to systemic hypertension | journal = Journal of Applied Physiology | volume = 109 | issue = 6 | pages = 1996–1998; discussion 2016 | date = December 2010 | pmid = 20185633 | doi = 10.1152/japplphysiol.00182.2010 | s2cid = 7685157 }}</ref> These mechanisms are not mutually exclusive, and both likely contribute to some extent in most cases of essential hypertension. It has also been suggested that [[endothelial dysfunction]] and vascular [[inflammation]] may also contribute to increased peripheral resistance and vascular damage in hypertension.<ref>{{cite journal | vauthors = Versari D, Daghini E, Virdis A, Ghiadoni L, Taddei S | title = Endothelium-dependent contractions and endothelial dysfunction in human hypertension | journal = British Journal of Pharmacology | volume = 157 | issue = 4 | pages = 527–536 | date = June 2009 | pmid = 19630832 | pmc = 2707964 | doi = 10.1111/j.1476-5381.2009.00240.x }}</ref><ref>{{cite journal | vauthors = Marchesi C, Paradis P, Schiffrin EL | title = Role of the renin-angiotensin system in vascular inflammation | journal = Trends in Pharmacological Sciences | volume = 29 | issue = 7 | pages = 367–374 | date = July 2008 | pmid = 18579222 | doi = 10.1016/j.tips.2008.05.003 }}</ref> [[Interleukin 17]] has garnered interest for its role in increasing the production of several other [[cytokine|immune system chemical signals]] thought to be involved in hypertension such as [[tumor necrosis factor alpha]], [[interleukin 1]], [[interleukin 6]], and [[interleukin 8]].<ref name="Gooch2014">{{cite journal | vauthors = Gooch JL, Sharma AC | title = Targeting the immune system to treat hypertension: where are we? | journal = Current Opinion in Nephrology and Hypertension | volume = 23 | issue = 5 | pages = 473–479 | date = September 2014 | pmid = 25036747 | doi = 10.1097/MNH.0000000000000052 | s2cid = 13383731 }}</ref>
Excessive [[sodium]] or insufficient [[potassium]] in the diet leads to excessive intracellular sodium, which contracts vascular smooth muscle, restricting blood flow and so increases blood pressure.<ref>{{cite journal | vauthors = Adrogué HJ, Madias NE | title = Sodium and potassium in the pathogenesis of hypertension | journal = The New England Journal of Medicine | volume = 356 | issue = 19 | pages = 1966–1978 | date = May 2007 | pmid = 17494929 | doi = 10.1056/NEJMra064486 | s2cid = 22345731 }}</ref><ref>{{cite journal | vauthors = Perez V, Chang ET | title = Sodium-to-potassium ratio and blood pressure, hypertension, and related factors | journal = Advances in Nutrition | volume = 5 | issue = 6 | pages = 712–741 | date = November 2014 | pmid = 25398734 | pmc = 4224208 | doi = 10.3945/an.114.006783 }}</ref> Non-modulating essential hypertension is a form of [[salt]]-sensitive hypertension, where [[sodium]] intake does not modulate either [[Adrenal gland|adrenal]] or [[Kidney|renal]] [[Vascular system|vascular]] responses to [[angiotensin II]].<ref>{{cite journal | vauthors = Williams GH, Hollenberg NK | title = Non-modulating essential hypertension: a subset particularly responsive to converting enzyme inhibitors | journal = Journal of Hypertension Supplement | volume = 3 | issue = 2 | pages = S81–S87 | date = November 1985 | pmid = 3003304 }}</ref> They make up 25% of the hypertensive population.<ref name="Harrison2018">{{Cite book |title=Harrison's Principles of Internal Medicine |date=2018 |publisher=McGraw-Hill Education |isbn=978-1-259-64404-7 |editor-last=Harrison |editor-first=Tinsley Randolph |edition=20th |editor-last2=Jameson |editor-first2=J. Larry |editor-last3=Fauci |editor-first3=Anthony S. |editor-last4=Kasper |editor-first4=Dennis L. |editor-last5=Hauser |editor-first5=Stephen L. |editor-last6=Longo |editor-first6=Dan L. |editor-last7=Loscalzo |editor-first7=Joseph | page = 1896 | quote = When plasma renin activity (PRA) is plotted against 24-h sodium excretion, ~10–15% of hypertensive patients have high PRA and 25% have low PRA. High-renin patients may have a vasoconstrictor form of hypertension, whereas low-renin patients may have volume-dependent hypertension. }}</ref>
==Diagnosis==
Hypertension is diagnosed based on persistently high resting blood pressure. Elevated blood pressure measurements on at least two separate occasions are required for a diagnosis of hypertension.<ref name="AHA2017"/><ref name="ESH2023"/><ref name="WHO2023"/>
===
For an accurate diagnosis of hypertension to be made, proper [[blood pressure measurement]] technique must be used.<ref name="Viera2017">{{cite journal | vauthors = Viera AJ | title = Screening for Hypertension and Lowering Blood Pressure for Prevention of Cardiovascular Disease Events | journal = The Medical Clinics of North America | volume = 101 | issue = 4 | pages = 701–712 | date = July 2017 | pmid = 28577621 | doi = 10.1016/j.mcna.2017.03.003 | type = Review }}</ref> Improper measurement of blood pressure is common and can change the blood pressure reading by up to 10 mmHg, which can lead to misdiagnosis and misclassification of hypertension.<ref name="Viera2017"/> The correct blood pressure measurement technique involves several steps. Proper blood pressure measurement requires the person whose blood pressure is being measured to sit quietly for at least five minutes, which is then followed by the application of a properly fitted blood pressure cuff to a bare upper arm.<ref name="Viera2017"/> The person should be seated with their back supported, feet flat on the floor, and with their legs uncrossed.<ref name="Viera2017"/> The person whose blood pressure is being measured should avoid talking or moving during this process.<ref name="Viera2017"/> The arm being measured should be supported on a flat surface at the level of the heart.<ref name="Viera2017"/> Blood pressure measurement should be done in a quiet room so the medical professional checking the blood pressure can hear the [[Korotkoff sound]]s while listening to the [[brachial artery]] with a [[stethoscope]] for accurate blood pressure measurements.<ref name="Viera2017"/><ref name="Vischer2017">{{cite book| vauthors = Vischer AS, Burkard T |title=Hypertension: From basic research to clinical practice |chapter=Principles of Blood Pressure Measurement – Current Techniques, Office vs Ambulatory Blood Pressure Measurement |series=Advances in Experimental Medicine and Biology|date=2017|volume=956|pages=85–96|doi=10.1007/5584_2016_49|pmid=27417699|type=Review|isbn=978-3-319-44250-1}}</ref> The blood pressure cuff should be deflated slowly (2–3 mmHg per second) while listening for the Korotkoff sounds.<ref name="Vischer2017"/> The [[urinary bladder|bladder]] should be emptied before a person's blood pressure is measured since this can increase blood pressure by up to 15/10 mmHg.<ref name="Viera2017"/> Multiple blood pressure readings (at least two) spaced 1–2 minutes apart should be obtained to ensure accuracy.<ref name="Vischer2017"/> Ambulatory blood pressure monitoring over 12 to 24 hours is the most accurate method to confirm the diagnosis.<ref name="ReferenceA">{{cite journal | vauthors = Siu AL | title = Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement | journal = Annals of Internal Medicine | volume = 163 | issue = 10 | pages = 778–786 | date = November 2015 | pmid = 26458123 | doi = 10.7326/m15-2223 | doi-access = free }}</ref> An exception to this is those with very high blood pressure readings, especially when there is poor [[organ (anatomy)|organ]] function.<ref name="NICE127 full"/>
With the availability of 24-hour [[ambulatory blood pressure]] monitors and [[bloodpressure#Home monitoring|home blood pressure]] machines, the importance of not wrongly diagnosing those who have [[white coat hypertension]] has led to a change in protocols. In the United Kingdom, the current best practice is to follow up a single raised clinic reading with ambulatory measurement, or, less ideally, with home blood pressure monitoring over 7 days.<ref name="NICE127 full">{{cite book |author=National Clinical Guidance Centre |title=Hypertension (NICE CG 127) |publisher=[[National Institute for Health and Clinical Excellence]] |chapter=7 Diagnosis of Hypertension, 7.5 Link from evidence to recommendations |pages=102 |date=August 2011 |chapter-url=http://www.nice.org.uk/nicemedia/live/13561/56007/56007.pdf |access-date=22 December 2011 |url-status=dead |archive-url=https://web.archive.org/web/20130723014309/http://www.nice.org.uk/nicemedia/live/13561/56007/56007.pdf |archive-date=23 July 2013 }}</ref> The [[United States Preventive Services Task Force]] also recommends getting measurements outside of the healthcare environment.<ref name="ReferenceA"/> [[Pseudohypertension in the elderly]] or noncompressibility artery syndrome may also require consideration. This condition is believed to be due to [[calcification]] of the arteries, resulting in abnormally high blood pressure readings with a blood pressure cuff, while intra-arterial measurements of blood pressure are normal.<ref>{{cite journal | vauthors = Franklin SS, Wilkinson IB, McEniery CM | title = Unusual hypertensive phenotypes: what is their significance? | journal = Hypertension | volume = 59 | issue = 2 | pages = 173–178 | date = February 2012 | pmid = 22184330 | doi = 10.1161/HYPERTENSIONAHA.111.182956 | doi-access = free }}</ref> [[Orthostatic hypertension]] is when blood pressure increases upon standing.<ref>{{cite journal | vauthors = Kario K | title = Orthostatic hypertension: a measure of blood pressure variation for predicting cardiovascular risk | journal = Circulation Journal | volume = 73 | issue = 6 | pages = 1002–1007 | date = June 2009 | pmid = 19430163 | doi = 10.1253/circj.cj-09-0286 | doi-access = free }}</ref>
=== Other investigations ===
{{anchor|Laboratory tests}}
Once the diagnosis of hypertension has been made, further testing may be performed to find [[secondary hypertension]], identify comorbidities such as [[diabetes]], identify hypertension-caused organ damage such as [[chronic kidney disease]] or [[left ventricular hypertrophy|thickening of the heart muscle]], and for [[cardiovascular disease]] risk stratification.<ref name="WHOreport2023"/>
Secondary hypertension is more common in preadolescent children, with most cases caused by [[kidney disease]]. Primary or [[essential hypertension]] is more common in adolescents and adults and has multiple risk factors, including obesity and a family history of hypertension.<ref name="pmid16719248">{{cite journal | vauthors = Luma GB, Spiotta RT | title = Hypertension in children and adolescents | journal = American Family Physician | volume = 73 | issue = 9 | pages = 1558–1568 | date = May 2006 | pmid = 16719248 }}</ref>
Initial assessment upon diagnosis of hypertension should include a complete [[Medical history|history]] and [[physical examination]]. The [[World Health Organization]] suggests the following initial tests: [[serum electrolytes]], [[serum creatinine]], [[lipid panel]], [[HbA1c]] or [[fasting glucose]], [[urine dipstick]] and [[electrocardiogram]] (ECG/EKG).<ref name="WHOreport2023"/> Serum creatinine is measured to assess for the presence of kidney disease, which can be either the cause or the result of hypertension.<ref name="JNC7">{{cite journal | vauthors = Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ | title = Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure | journal = Hypertension | volume = 42 | issue = 6 | pages = 1206–1252 | date = December 2003 | pmid = 14656957 | doi = 10.1161/01.HYP.0000107251.49515.c2 | collaboration = Joint National Committee on Prevention, National High Blood Pressure Education Program Coordinating Committee | doi-access = free }}</ref> eGFR can also provide a baseline measurement of kidney function that can be used to monitor for side effects of certain [[Antihypertensive drug|anti-hypertensive drugs]] on kidney function. Testing of [[proteinuria|urine samples for protein]] is used as a secondary indicator of kidney disease. Lipid panel and glucose tests are done to identify comorbidities such as diabetes and [[hyperlipidemia]] and for cardiovascular risk stratification. Electrocardiogram (EKG/ECG) testing is done to check for evidence that the heart is under strain from high blood pressure, such as [[left ventricular hypertrophy|thickening of the heart muscle]] or whether the heart has experienced a prior minor disturbance, such as a silent heart attack.
===Classification in adults===
The circumstances of measurement can influence blood pressure measurements.<ref name=ESC2024/> Guidelines use different thresholds for office (also known as clinic), home (when the patient measures their blood pressure at home), and [[ambulatory blood pressure]] (using an automated device over 24 hours).<ref name=ESC2024/>
{| class="wikitable"
|+ Blood pressure classifications
|-
! Categories
! colspan="3" | [[Systolic blood pressure]], [[mmHg]]
! rowspan=2 | and/or
! colspan="3" | [[Diastolic blood pressure]], mmHg
|-
! Method
! Office
! Home
! 24h [[Ambulatory blood pressure|ambulatory]]
! Office
! Home
! 24h ambulatory
|-
! colspan="8" | [[American College of Cardiology]]/[[American Heart Association]] (2017)<ref name=Whelton2022>{{Cite journal |last1=Whelton |first1=Paul K |last2=Carey |first2=Robert M |last3=Mancia |first3=Giuseppe |last4=Kreutz |first4=Reinhold |last5=Bundy |first5=Joshua D |last6=Williams |first6=Bryan |date=2022-09-14 |title=Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension Blood Pressure/Hypertension Guidelines |journal=European Heart Journal |language=en |volume=43 |issue=35 |pages=3302–3311 |doi=10.1093/eurheartj/ehac432 |doi-access = free |issn=0195-668X |pmc=9470378 |pmid=36100239}}</ref>
|-
| Normal
| <120
|<120
| <115
| and
| <80
|<80
| <75
|-
| Elevated
| 120–129
|120–129
| 115–124
| and
| <80
|<80
| <75
|-
| Hypertension, stage 1
| 130–139
|130–134
| 125–129
| or
| 80–89
|80–84
| 75–79
|-
| Hypertension, stage 2
| ≥140
|≥135
| ≥130
| or
| ≥90
|≥85
| ≥80
|-
! colspan="8" | [[European Society of Cardiology]] (2024)<ref name=ESC2024>{{Cite journal |last1=McEvoy |first1=John William |last2=McCarthy |first2=Cian P |last3=Bruno |first3=Rosa Maria |last4=Brouwers |first4=Sofie |last5=Canavan |first5=Michelle D |last6=Ceconi |first6=Claudio |last7=Christodorescu |first7=Ruxandra Maria |last8=Daskalopoulou |first8=Stella S |last9=Ferro |first9=Charles J |last10=Gerdts |first10=Eva |last11=Hanssen |first11=Henner |last12=Harris |first12=Julie |last13=Lauder |first13=Lucas |last14=McManus |first14=Richard J |last15=Molloy |first15=Gerard J |display-authors=5 |date=2024-08-30 |title=2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO) |journal=European Heart Journal |volume=45 |issue=38 |pages=3912–4018 |language=en |doi=10.1093/eurheartj/ehae178 |doi-access=free |pmid=39210715 |issn=0195-668X}}</ref>
|-
| Non-elevated
| <120
|<120
| <115
| and
| <70
|<70
| <65
|-
| Elevated
| 120–139
|120–135
| 115–129
| and
| 70–89
|70–85
| 65–79
|-
| Hypertension
| ≥140
|≥135
| ≥130
| or
| ≥90
|≥85
| ≥80
|-
! colspan="8" | [[European Society of Hypertension]]/[[International Society of Hypertension]] (2023)<ref name=ESH2023>{{Cite journal |last1=Mancia |first1=Giuseppe |last2=Kreutz |first2=Reinhold |last3=Brunström |first3=Mattias |last4=Burnier |first4=Michel |last5=Grassi |first5=Guido |last6=Januszewicz |first6=Andrzej |last7=Muiesan |first7=Maria Lorenza |last8=Tsioufis |first8=Konstantinos |last9=Agabiti-Rosei |first9=Enrico |last10=Algharably |first10=Engi Abd Elhady |last11=Azizi |first11=Michel |last12=Benetos |first12=Athanase |last13=Borghi |first13=Claudio |last14=Hitij |first14=Jana Brguljan |last15=Cifkova |first15=Renata |display-authors = 5 |date=2023-12-01 |title=2023 ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA) |journal=Journal of Hypertension |volume=41 |issue=12 |pages=1874–2071 |doi=10.1097/HJH.0000000000003480 |issn=1473-5598 |pmid=37345492|doi-access=free |hdl=11379/603005 |hdl-access=free }}</ref>
|-
| Optimal
| <120
| {{N/A}}
| {{N/A}}
| and
| <80
| {{N/A}}
| {{N/A}}
|-
| Normal
| 120–129
| {{N/A}}
| {{N/A}}
| and/or
| 80–84
| {{N/A}}
| {{N/A}}
|-
| High normal
| 130–139
| {{N/A}}
| {{N/A}}
| and/or
| 85–89
| {{N/A}}
| {{N/A}}
|-
| Hypertension, grade 1
| 140–159
|≥135
| ≥130
| and/or
| 90–99
|≥85
| ≥80
|-
| Hypertension, grade 2
| 160–179
| {{N/A}}
| {{N/A}}
| and/or
| 100–109
| {{N/A}}
| {{N/A}}
|-
| Hypertension, grade 3
| ≥180
| {{N/A}}
| {{N/A}}
| and/or
| ≥110
| {{N/A}}
| {{N/A}}
|}
===
Hypertension occurs in around 0.2 to 3% of newborns; however, blood pressure is not measured routinely in healthy newborns.<ref name=Dionne>{{cite journal | vauthors = Dionne JM, Abitbol CL, Flynn JT | title = Hypertension in infancy: diagnosis, management and outcome | journal = Pediatric Nephrology | volume = 27 | issue = 1 | pages = 17–32 | date = January 2012 | pmid = 21258818 | doi = 10.1007/s00467-010-1755-z | s2cid = 10698052 }}</ref> Hypertension is more common in high risk newborns. A variety of factors, such as [[Gestational age (obstetrics)|gestational age]], postconceptional age, and [[birth weight]] need to be taken into account when deciding if blood pressure is normal in a newborn.<ref name=Dionne />
Hypertension, defined as elevated blood pressure over several visits, affects 1% to 5% of children and adolescents and is associated with long-term risks of ill-health.<ref name=fourth>{{cite journal | title = The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents | journal = Pediatrics | volume = 114 | issue = 2 Suppl 4th Report | pages = 555–576 | date = August 2004 | pmid = 15286277 | doi = 10.1542/peds.114.2.S2.555 | author1 = National High Blood Pressure Education Program Working Group on High Blood Pressure in Children Adolescents | doi-broken-date = 3 July 2025 | hdl = 2027/uc1.c095473177 | hdl-access = free }}</ref> Blood pressure rises with age in childhood, and, in children, hypertension is defined as an average systolic or diastolic blood pressure on three or more occasions equal or higher than the 95th percentile appropriate for the sex, age, and height of the child. High blood pressure must be confirmed on repeated visits, however, before characterizing a child as having hypertension.<ref name=fourth /> In adolescents, it has been proposed that hypertension is diagnosed and classified using the same criteria as in adults.<ref name=fourth />
==Prevention==
Much of the disease burden of high blood pressure is experienced by people who are not labeled as hypertensive.<ref name=BHSIV>{{cite journal | vauthors = Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, Sever PS, McG Thom S | title = Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV | journal = Journal of Human Hypertension | volume = 18 | issue = 3 | pages = 139–185 | date = March 2004 | pmid = 14973512 | doi = 10.1038/sj.jhh.1001683 | doi-access = free }}</ref> Consequently, [[public health|population strategies]] are required to reduce the consequences of high blood pressure and reduce the need for antihypertensive medications. Lifestyle changes are recommended to lower blood pressure.
Recommended lifestyle changes for the prevention of hypertension include:
* maintain normal body weight for adults (e.g. [[body mass index]] below 25 kg/m<sup>2</sup>)<ref name=ESH2023/>
* [[Salt and cardiovascular disease|reduce dietary sodium intake]] to <100 mmol/day (<6 g of salt (sodium chloride) or <2.4 g of sodium per day)<ref name=ESH2023/>
* engage in regular aerobic physical activity with moderate intensity (minimum 150 minutes per week)<ref name=ESH2023/>
* limit alcohol consumption,<ref name=ESH2023/> max 1 drink for women and 2 for men per day<ref name="WHO2023"/>
* consume a diet rich in whole grains, fruits, and vegetables,<ref name=ESH2023/> such as the [[DASH diet]]<ref name=ESH2023/>
* [[smoking cessation|not smoking]]<ref name=ESH2023/>
* stress reduction and management,<ref name=ESH2023/> e.g. by meditation and [[yoga]]<ref name=ESH2023/>
Effective lifestyle modification may lower blood pressure as much as an individual antihypertensive medication. Combinations of two or more lifestyle modifications can achieve even better results.<ref name="BHSIV"/> There is considerable evidence that [[Salt and cardiovascular disease|reducing dietary salt intake lowers blood pressure]], but whether this translates into a reduction in mortality and cardiovascular disease remains uncertain.<ref name="Salt2016">{{cite journal | vauthors = <!-- No authors listed --> | title = Evidence-based policy for salt reduction is needed | journal = Lancet | volume = 388 | issue = 10043 | pages = 438 | date = July 2016 | pmid = 27507743 | doi = 10.1016/S0140-6736(16)31205-3 | s2cid = 205982690 }}</ref> Estimated sodium intake ≥6 g/day and <3 g/day are both associated with high risk of death or major cardiovascular disease, but the association between high sodium intake and adverse outcomes is only observed in people with hypertension.<ref>{{cite journal | vauthors = Mente A, O'Donnell M, Rangarajan S, Dagenais G, Lear S, McQueen M, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Li W, Lu Y, Yi S, Rensheng L, Iqbal R, Mony P, Yusuf R, Yusoff K, Szuba A, Oguz A, Rosengren A, Bahonar A, Yusufali A, Schutte AE, Chifamba J, Mann JF, Anand SS, Teo K, Yusuf S | title = Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies | journal = Lancet | volume = 388 | issue = 10043 | pages = 464–475 | date = July 2016 | pmid = 27216139 | doi = 10.1016/S0140-6736(16)30467-6 | s2cid = 44581906 | url = https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/331|quote=The results showed that cardiovascular disease and death are increased with low sodium intake (compared with moderate intake) irrespective of hypertension status, whereas there is a higher risk of cardiovascular disease and death only in individuals with hypertension consuming more than 6 g of sodium per day (representing only 10% of the population studied)| hdl = 10379/16625 | hdl-access = free }}</ref> Consequently, in the absence of results from randomized controlled trials, the wisdom of reducing levels of dietary sodium intake below 3 g/day has been questioned.<ref name="Salt2016"/> ESC guidelines mention [[periodontitis]] is associated with poor cardiovascular health status.<ref>{{cite journal | vauthors = Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvänne M, Scholte op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F | title = European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) | journal = European Heart Journal | volume = 33 | issue = 13 | pages = 1635–1701 | date = July 2012 | pmid = 22555213 | doi = 10.1093/eurheartj/ehs092 | doi-access = free }}</ref>
The value of routine screening for hypertension is debated.<ref>{{cite journal | vauthors = Chiolero A, Bovet P, Paradis G | title = Screening for elevated blood pressure in children and adolescents: a critical appraisal | journal = JAMA Pediatrics | volume = 167 | issue = 3 | pages = 266–273 | date = March 2013 | pmid = 23303490 | doi = 10.1001/jamapediatrics.2013.438 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Daniels SR, Gidding SS | title = Blood pressure screening in children and adolescents: is the glass half empty or more than half full? | journal = JAMA Pediatrics | volume = 167 | issue = 3 | pages = 302–304 | date = March 2013 | pmid = 23303514 | doi = 10.1001/jamapediatrics.2013.439 }}</ref><ref name=":0">{{cite journal | vauthors = Schmidt BM, Durao S, Toews I, Bavuma CM, Hohlfeld A, Nury E, Meerpohl JJ, Kredo T | display-authors = 6 | title = Screening strategies for hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 5 | pages = CD013212 | date = May 2020 | pmid = 32378196 | pmc = 7203601 | doi = 10.1002/14651858.CD013212.pub2 | collaboration = Cochrane Hypertension Group }}</ref> In 2004, the National High Blood Pressure Education Program recommended that children aged 3 years and older have blood pressure measurement at least once at every health care visit<ref name="fourth" /> and the [[National Heart, Lung, and Blood Institute]] and [[American Academy of Pediatrics]] made a similar recommendation.<ref>{{cite journal | vauthors = | title = Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report | journal = Pediatrics | volume = 128 | issue = Suppl 5 | pages = S213–S256 | date = December 2011 | pmid = 22084329 | pmc = 4536582 | doi = 10.1542/peds.2009-2107C }}</ref> However, the [[American Academy of Family Physicians]]<ref>{{cite web |title=Hypertension – Clinical Preventive Service Recommendation |website=AAFP |url=http://www.aafp.org/patient-care/clinical-recommendations/all/hypertension.html |url-status=dead |archive-url=https://web.archive.org/web/20141101212302/http://www.aafp.org/patient-care/clinical-recommendations/all/hypertension.html |archive-date=1 November 2014 |access-date=2013-10-13}}</ref> supports the view of the [[United States Preventive Services Task Force|U.S. Preventive Services Task Force]] that the available evidence is insufficient to determine the balance of benefits and harms of screening for hypertension in children and adolescents who do not have symptoms.<ref name="Moyer2013">{{cite journal | vauthors = Moyer VA | title = Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement | journal = Annals of Internal Medicine | volume = 159 | issue = 9 | pages = 613–619 | date = November 2013 | pmid = 24097285 | doi = 10.7326/0003-4819-159-9-201311050-00725 | s2cid = 20193715 |doi-access=free |s2cid-access=free }}</ref><ref>{{cite web |title=Document {{!}} United States Preventive Services Taskforce |url=https://www.uspreventiveservicestaskforce.org/uspstf/document?DOC=draft-recommendation-statement&TOPIC=high-blood-pressure-in-children-and-adolescents-screening-2020 |url-status=dead |archive-url=https://web.archive.org/web/20200522054932/https://www.uspreventiveservicestaskforce.org/uspstf/document?DOC=draft-recommendation-statement&TOPIC=high-blood-pressure-in-children-and-adolescents-screening-2020 |archive-date=22 May 2020 |access-date=22 April 2020 |website=uspreventiveservicestaskforce.org}}</ref> The US Preventive Services Task Force recommends screening adults 18 years or older for hypertension with office blood pressure measurement.<ref name=":0" /><ref>{{cite journal | vauthors = Krist AH, Davidson KW, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB | display-authors = 6 | title = Screening for Hypertension in Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement | journal = JAMA | volume = 325 | issue = 16 | pages = 1650–1656 | date = April 2021 | pmid = 33904861 | doi = 10.1001/jama.2021.4987 | s2cid = 233409679 | doi-access = free }}</ref>
==Management==
{{Main|Management of hypertension}}
According to one review published in 2003, reduction of the [[blood pressure]] by 5 mmHg can decrease the risk of stroke by 34%, of [[ischemic heart disease]] by 21%, and reduce the likelihood of [[dementia]], [[heart failure]], and [[death|mortality]] from [[cardiovascular disease]].<ref>{{cite journal | vauthors = Law M, Wald N, Morris J | title = Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy | journal = Health Technology Assessment | volume = 7 | issue = 31 | pages = 1–94 | year = 2003 | pmid = 14604498 | doi = 10.3310/hta7310 | doi-access = free }}</ref>
=== Target blood pressure ===
{{See also|Comparison of international blood pressure guidelines}}
Various expert groups have produced guidelines regarding how low the blood pressure target should be when a person is treated for hypertension. These groups recommend a target below the range of 140–160 / 90–100 mmHg for the general population.<ref name="ESH2023" /><ref name="JNC8"/><ref name="Daskalopoulou_2015">{{cite journal | vauthors = Daskalopoulou SS, Rabi DM, Zarnke KB, Dasgupta K, Nerenberg K, Cloutier L, etal | title = The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension | journal = The Canadian Journal of Cardiology | volume = 31 | issue = 5 | pages = 549–568 | date = May 2015 | pmid = 25936483 | doi = 10.1016/j.cjca.2015.02.016 | url = https://escholarship.mcgill.ca/concern/articles/rb68xh61n | doi-access = free }}</ref><ref name="NICE">{{cite web | title = Hypertension: Recommendations, Guidance and guidelines | work = NICE | url = http://www.nice.org.uk | archive-url=https://web.archive.org/web/20061003082330/http://www.nice.org.uk/ | archive-date = 3 October 2006 | access-date = 4 August 2015 }}</ref> [[Cochrane (organisation)|Cochrane]] reviews recommend similar targets for subgroups such as people with diabetes<ref name="Arg2013">{{cite journal | vauthors = Arguedas JA, Leiva V, Wright JM | title = Blood pressure targets for hypertension in people with diabetes mellitus | journal = The Cochrane Database of Systematic Reviews | issue = 10 | pages = CD008277 | date = October 2013 | pmid = 24170669 | doi = 10.1002/14651858.cd008277.pub2 | pmc = 11365096 }}</ref> and people with prior cardiovascular disease.<ref>{{cite journal | vauthors = Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L | title = Blood pressure targets for the treatment of people with hypertension and cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 11 | pages = CD010315 | date = November 2022 | pmid = 36398903 | pmc = 9673465 | doi = 10.1002/14651858.CD010315.pub5 }}</ref> Additionally, Cochrane reviews have found that for older individuals with moderate to high cardiovascular risk, the benefits of trying to achieve a lower-than-standard blood pressure target (at or below 140/90 mmHg) are outweighed by the risk associated with the intervention.<ref name="Arguedas_2020">{{cite journal | vauthors = Arguedas JA, Leiva V, Wright JM | title = Blood pressure targets in adults with hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 12 | pages = CD004349 | date = December 2020 | pmid = 33332584 | pmc = 8094587 | doi = 10.1002/14651858.CD004349.pub3 }}</ref> These findings may not be applicable to other populations.<ref name="Arguedas_2020" />
Many expert groups recommend a slightly higher target of 150/90 mmHg for those somewhere between 60 and 80 years of age.<ref name="Daskalopoulou_2015"/><ref name="NICE"/><ref name=ACP2017>{{cite journal | vauthors = Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA | title = Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians | journal = Annals of Internal Medicine | volume = 166 | issue = 6 | pages = 430–437 | date = March 2017 | pmid = 28135725 | doi = 10.7326/M16-1785 | doi-access = free }}</ref> The JNC 8 and [[American College of Physicians]] recommend the target of 150/90 mmHg for those over 60 years of age,<ref name="JNC8"/><ref name=ACP2017/> but some experts within these groups disagree with this recommendation.<ref>{{cite journal | vauthors = Wright JT, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR | title = Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view | journal = Annals of Internal Medicine | volume = 160 | issue = 7 | pages = 499–503 | date = April 2014 | pmid = 24424788 | doi = 10.7326/m13-2981 | doi-access = free }}</ref> Some expert groups have also recommended slightly lower targets in those with [[diabetes]]<ref name=ADA2018>{{Cite journal |last1=Passarella |first1=Pasquale |last2=Kiseleva |first2=Tatiana A. |last3=Valeeva |first3=Farida V. |last4=Gosmanov |first4=Aidar R. |date=2018-08-01 |title=Hypertension Management in Diabetes: 2018 Update |journal=Diabetes Spectrum |language=en |volume=31 |issue=3 |pages=218–224 |doi=10.2337/ds17-0085 |issn=1040-9165 |pmc=6092891 |pmid=30140137}}</ref> or [[chronic kidney disease]],<ref name=KDIGO2022>{{Cite journal |last1=Cheung |first1=Alfred K. |last2=Chang |first2=Tara I. |last3=Cushman |first3=William C. |last4=Furth |first4=Susan L. |last5=Hou |first5=Fan Fan |last6=Ix |first6=Joachim H. |last7=Knoll |first7=Gregory A. |last8=Muntner |first8=Paul |last9=Pecoits-Filho |first9=Roberto |last10=Sarnak |first10=Mark J. |last11=Tobe |first11=Sheldon W. |last12=Tomson |first12=Charles R.V. |last13=Mann |first13=Johannes F.E. |date=March 2021 |title=KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease |journal=Kidney International |language=en |volume=99 |issue=3 |pages=S1–S87 |doi=10.1016/j.kint.2020.11.003|doi-access=free |pmid=33637192 }}</ref> but others recommend the same target as the general population.<ref name="JNC8"/><ref name=Arg2013/> The issue of what is the best target and whether targets should differ for high-risk individuals is unresolved,<ref>{{cite journal | vauthors = Brunström M, Carlberg B | title = Lower blood pressure targets: to whom do they apply? | journal = Lancet | volume = 387 | issue = 10017 | pages = 405–406 | date = January 2016 | pmid = 26559745 | doi = 10.1016/S0140-6736(15)00816-8 | s2cid = 44282689 | url = https://zenodo.org/record/896834 }}</ref> although some experts propose more intensive blood pressure lowering than advocated in some guidelines.<ref>{{cite journal | vauthors = Xie X, Atkins E, Lv J, Rodgers A | title = Intensive blood pressure lowering – Authors' reply | journal = Lancet | volume = 387 | issue = 10035 | pages = 2291 | date = June 2016 | pmid = 27302266 | doi = 10.1016/S0140-6736(16)30366-X | doi-access = free }}</ref>
For people who have never experienced cardiovascular disease and who are at a 10-year risk of cardiovascular disease of less than 10%, the 2017 American Heart Association guidelines recommend medications if the systolic blood pressure is >140 mmHg or if the diastolic BP is >90 mmHg.<ref name="AHA2017"/> For people who have experienced cardiovascular disease or those who are at a 10-year risk of cardiovascular disease of greater than 10%, it recommends medications if the systolic blood pressure is >130 mmHg or if the diastolic BP is >80 mmHg.<ref name="AHA2017"/>
===Lifestyle modifications===
The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical activity, and weight loss. Though these have all been recommended in scientific advisories,<ref name="Go2013">{{cite journal | vauthors = Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, Sanchez E | title = An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention | journal = Hypertension | volume = 63 | issue = 4 | pages = 878–885 | date = April 2014 | pmid = 24243703 | doi = 10.1161/HYP.0000000000000003 | pmc = 10280688 | doi-access = free }}</ref> a [[Cochrane (organisation)|Cochrane]] systematic review found no evidence (due to lack of data) for effects of weight loss diets on death, long-term complications or adverse events in persons with hypertension.<ref name="Semlitsch_2021">{{cite journal | vauthors = Semlitsch T, Krenn C, Jeitler K, Berghold A, Horvath K, Siebenhofer A | title = Long-term effects of weight-reducing diets in people with hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 2 | pages = CD008274 | date = February 2021 | pmid = 33555049 | pmc = 8093137 | doi = 10.1002/14651858.CD008274.pub4 }}</ref> The review did find a decrease in body weight and blood pressure.<ref name="Semlitsch_2021" /> Their potential effectiveness is similar to and at times exceeds a single medication.<ref name="ESH2023"/> If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication.
Dietary changes shown to reduce blood pressure include diets with low sodium,<ref name="Cochrane2013">{{cite journal | vauthors = He FJ, Li J, Macgregor GA | title = Effect of longer-term modest salt reduction on blood pressure | journal = The Cochrane Database of Systematic Reviews | volume = 30 | issue = 4 | pages = CD004937 | date = April 2013 | pmid = 23633321 | doi = 10.1002/14651858.CD004937.pub2 | type = Systematic Review & Meta-Analysis | s2cid = 23522004 | pmc = 11537250 }}</ref><ref>{{cite journal | vauthors = Huang L, Trieu K, Yoshimura S, Neal B, Woodward M, Campbell NR, Li Q, Lackland DT, Leung AA, Anderson CA, MacGregor GA, He FJ | display-authors = 6 | title = Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials | journal = The BMJ | volume = 368 | pages = m315 | date = February 2020 | pmid = 32094151 | pmc = 7190039 | doi = 10.1136/bmj.m315 | doi-access = free }}</ref> the [[DASH diet]] (Dietary Approaches to Stop Hypertension),<ref>{{cite journal | vauthors = Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH | display-authors = 6 | title = Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group | journal = The New England Journal of Medicine | volume = 344 | issue = 1 | pages = 3–10 | date = January 2001 | pmid = 11136953 | doi = 10.1056/NEJM200101043440101 | doi-access = free }}</ref> which was the best against 11 other diet in an umbrella review,<ref>{{cite journal | vauthors = Sukhato K, Akksilp K, Dellow A, Vathesatogkit P, Anothaisintawee T | title = Efficacy of different dietary patterns on lowering of blood pressure level: an umbrella review | journal = The American Journal of Clinical Nutrition | volume = 112 | issue = 6 | pages = 1584–1598 | date = December 2020 | pmid = 33022695 | doi = 10.1093/ajcn/nqaa252 | doi-access = free }}</ref> and plant-based diets.<ref name="pmid33281520">{{cite journal | vauthors = Joshi S, Ettinger L, Liebman SE | title = Plant-Based Diets and Hypertension | journal = American Journal of Lifestyle Medicine | volume = 14 | issue = 4 | pages = 397–405 | year = 2020 | pmid = 33281520 | pmc = 7692016 | doi = 10.1177/1559827619875411 }}</ref> A 2024 clinical guideline recommended an increase [[dietary fiber]] intake,<ref name="PMID37712135">{{cite journal | vauthors = Charchar FJ, Prestes PR, Mills C | title = Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension | journal = Journal of Hypertension | volume = 42 | issue = 1 | pages = 23–49 | year = 2024 | pmid = 37712135| pmc = 10713007 | doi = 10.1097/HJH.0000000000003563}}</ref> with a minimum of 28g/day for women and 38g/day for men diagnosed with hypertension.<ref name="PMID38586958">{{cite journal | vauthors = Jama, HA, Snelson M, Schutte AE | title = Recommendations for the Use of Dietary Fiber to Improve Blood Pressure Control | journal = Hypertension | volume = 81 | issue = 7 | pages = 1450–1459 | year = 2024 | pmid = 38586958 | doi = 10.1161/HYPERTENSIONAHA.123.22575}}</ref>
Increasing [[Potassium#Nutrition|dietary potassium]] has a potential benefit for lowering the risk of hypertension.<ref>{{cite journal | vauthors = Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP | title = Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses | journal = The BMJ | volume = 346 | pages = f1378 | date = April 2013 | pmid = 23558164 | pmc = 4816263 | doi = 10.1136/bmj.f1378 }}</ref><ref>{{cite journal | vauthors = Stone MS, Martyn L, Weaver CM | title = Potassium Intake, Bioavailability, Hypertension, and Glucose Control | journal = Nutrients | volume = 8 | issue = 7 | pages = 444 | date = July 2016 | pmid = 27455317 | pmc = 4963920 | doi = 10.3390/nu8070444 | doi-access = free }}</ref> The 2015 Dietary Guidelines Advisory Committee (DGAC) stated that potassium is one of the shortfall nutrients which is under-consumed in the United States.<ref>{{cite web|title = Scientific Report of the 2015 Dietary Guidelines Advisory Committee|url = https://health.gov/dietaryguidelines/2015-scientific-report/|access-date = 2017-04-26|url-status = live|archive-url = https://web.archive.org/web/20170426153317/https://health.gov/dietaryguidelines/2015-scientific-report/|archive-date = 26 April 2017}}</ref> However, people who take certain antihypertensive medications (such as ACE-inhibitors or ARBs) should not take potassium supplements or potassium-enriched salts due to the risk of high levels of potassium.<ref>{{cite journal | vauthors = Raebel MA | title = Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers | journal = Cardiovascular Therapeutics | volume = 30 | issue = 3 | pages = e156–166 | date = June 2012 | pmid = 21883995 | doi = 10.1111/j.1755-5922.2010.00258.x | doi-access = free }}</ref>
Physical exercise regimens which are shown to reduce blood pressure include [[isometric exercise|isometric resistance exercise]], [[aerobic exercise]], [[resistance exercise]], and device-guided breathing.<ref name="Brook2013">{{cite journal | vauthors = Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S | title = Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association | journal = Hypertension | volume = 61 | issue = 6 | pages = 1360–1383 | date = June 2013 | pmid = 23608661 | doi = 10.1161/HYP.0b013e318293645f | doi-access = free }}</ref>
A 2020 [[Cochrane (organisation)|Cochrane]] review examined the impact of walking on blood pressure and heart rate in adults. The review found that walking likely reduces [[Blood pressure|systolic blood pressure]], with consistent effects across different age groups and both sexes.
There was also some evidence that walking may lower [[Blood pressure|diastolic blood pressure]] and [[Heart rate|heart rate]]. Overall, the certainty of evidence ranged from moderate to low, depending on the outcome and subgroup. Walking appears to be a safe, accessible, and potentially effective strategy for supporting cardiovascular health. <ref>{{cite journal | vauthors = Lou Y, Ye G, Liu W, Lv Z, Jia Y, Li C, Zhang Y | title = Walking for hypertension | journal = The Cochrane Database of Systematic Reviews | date = February 2021 | volume = 2013 | issue = 3 | pages = CD004937 | pmid = 23633321 | doi = 10.1002/14651858.CD008823.pub2 | pmc = 11537250 | type = Systematic Review & Meta-Analysis }}</ref>
Stress reduction techniques such as [[biofeedback]] or [[transcendental meditation]] may be considered as an add-on to other treatments to reduce hypertension, but do not have evidence for preventing cardiovascular disease on their own.<ref name="Brook2013"/><ref name="NageleJeitler2014">{{cite journal | vauthors = Nagele E, Jeitler K, Horvath K, Semlitsch T, Posch N, Herrmann KH, Grouven U, Hermanns T, Hemkens LG, Siebenhofer A | title = Clinical effectiveness of stress-reduction techniques in patients with hypertension: systematic review and meta-analysis | journal = Journal of Hypertension | volume = 32 | issue = 10 | pages = 1936–1944; discussion 1944 | date = October 2014 | pmid = 25084308 | doi = 10.1097/HJH.0000000000000298 | s2cid = 20098894 }}</ref><ref>{{cite journal | vauthors = Dickinson HO, Campbell F, Beyer FR, Nicolson DJ, Cook JV, Ford GA, Mason JM | title = Relaxation therapies for the management of primary hypertension in adults | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD004935 | date = January 2008 | pmid = 18254065 | doi = 10.1002/14651858.CD004935.pub2 }}</ref> Self-monitoring and appointment reminders might support the use of other strategies to improve blood pressure control, but need further evaluation.<ref name=":5">{{cite journal | vauthors = Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T | title = Interventions used to improve control of blood pressure in patients with hypertension | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD005182 | date = March 2010 | pmid = 20238338 | doi = 10.1002/14651858.cd005182.pub4 | url = http://researchonline.lshtm.ac.uk/10814/1/Fahey_et_al-2006-The_Cochrane_library.pdf | access-date = 11 February 2019 | archive-url = https://web.archive.org/web/20190412075644/http://researchonline.lshtm.ac.uk/10814/1/Fahey_et_al-2006-The_Cochrane_library.pdf | archive-date = 12 April 2019 | url-status = live | hdl = 10344/9179 | hdl-access = free }}</ref>
===Medications===
Several classes of medications, collectively referred to as [[antihypertensive drug|antihypertensive medication]]s, are available for treating hypertension.
First-line medications for hypertension include [[Thiazide|thiazide-diuretics]], [[calcium channel blockers]], [[angiotensin converting enzyme inhibitor]]s (ACE inhibitors), and [[Angiotensin II receptor blocker|angiotensin receptor blockers]] (ARBs).<ref>{{cite journal | vauthors = Wright JM, Musini VM, Gill R | title = First-line drugs for hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 4 | pages = CD001841 | date = April 2018 | pmid = 29667175 | pmc = 6513559 | doi = 10.1002/14651858.CD001841.pub3 }}</ref><ref name=JNC8/> These medications may be used alone or in combination (ACE inhibitors and ARBs are not recommended for use together); the latter option may serve to minimize counter-regulatory mechanisms that act to restore blood pressure values to pre-treatment levels,<ref name=JNC8/><ref>{{cite journal | vauthors = Chen JM, Heran BS, Wright JM | title = Blood pressure lowering efficacy of diuretics as second-line therapy for primary hypertension | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD007187 | date = October 2009 | pmid = 19821398 | doi = 10.1002/14651858.CD007187.pub2 | s2cid = 73993182 }}</ref> although the evidence for first-line combination therapy is not strong enough.<ref>{{cite journal | vauthors = Garjón J, Saiz LC, Azparren A, Gaminde I, Ariz MJ, Erviti J | title = First-line combination therapy versus first-line monotherapy for primary hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | pages = CD010316 | date = February 2020 | pmid = 32026465 | pmc = 7002970 | doi = 10.1002/14651858.CD010316.pub3 | collaboration = Cochrane Hypertension Group }}</ref> Most people require more than one medication to control their hypertension.<ref name="Go2013"/> Medications for blood pressure control should be implemented by a stepped care approach when target levels are not reached.<ref name=":5"/> Withdrawal of such medications in the elderly can be considered by healthcare professionals, because there is no strong evidence of an effect on mortality, [[myocardial infarction]], or [[stroke]].<ref>{{cite journal | vauthors = Reeve E, Jordan V, Thompson W, Sawan M, Todd A, Gammie TM, Hopper I, Hilmer SN, Gnjidic D | display-authors = 6 | title = Withdrawal of antihypertensive drugs in older people | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 6 | pages = CD012572 | date = June 2020 | pmid = 32519776 | pmc = 7387859 | doi = 10.1002/14651858.CD012572.pub2 | collaboration = Cochrane Hypertension Group }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/40162571|date = June 2025}}
Previously, [[beta-blockers]] such as [[atenolol]] were thought to have similar beneficial effects when used as first-line therapy for hypertension. However, a Cochrane review that included 13 trials found that the effects of beta-blockers are inferior to those of other antihypertensive medications in preventing cardiovascular disease.<ref>{{cite journal | vauthors = Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH | title = Beta-blockers for hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD002003 | date = January 2017 | issue = 1 | pmid = 28107561 | pmc = 5369873 | doi = 10.1002/14651858.CD002003.pub5 }}</ref>
The prescription of antihypertensive medication for children with hypertension has limited evidence. There is limited evidence that compares it with a placebo and shows a modest effect on blood pressure in the short term. Administration of a higher dose did not reduce blood pressure further.<ref>{{cite journal | vauthors = Chaturvedi S, Lipszyc DH, Licht C, Craig JC, Parekh R | title = Pharmacological interventions for hypertension in children | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD008117 | date = February 2014 | pmid = 24488616 | doi = 10.1002/14651858.CD008117.pub2 | collaboration = Cochrane Hypertension Group | pmc = 11056235 }}</ref>
===Resistant hypertension===
Resistant hypertension is defined as high blood pressure that remains above a target level, despite being prescribed three or more antihypertensive drugs simultaneously with different [[mechanism of action|mechanisms of action]].<ref name="pmid38372970">{{cite journal | vauthors = Giacona JM, Kositanurit W, Vongpatanasin W | title = Management of Resistant Hypertension-An Update | journal = JAMA Intern Med | volume = 184 | issue = 4 | pages = 433–434 | date = April 2024 | pmid = 38372970 | doi = 10.1001/jamainternmed.2023.8555 }}</ref> [[Adherence (medicine)|Failing to take prescribed medications as directed]] is an important cause of resistant hypertension.<ref>{{cite journal | vauthors = Santschi V, Chiolero A, Burnier M | title = Electronic monitors of drug adherence: tools to make rational therapeutic decisions | journal = Journal of Hypertension | volume = 27 | issue = 11 | pages = 2294–2295; author reply 2295 | date = November 2009 | pmid = 20724871 | doi = 10.1097/hjh.0b013e328332a501 }}</ref>
Some common secondary causes of resistant hypertension include [[obstructive sleep apnea]], [[primary aldosteronism]] and [[renal artery stenosis]], and some rare secondary causes are [[pheochromocytoma]] and [[coarctation of the aorta]].<ref>{{cite journal | vauthors = Sarwar MS, Islam MS, Al Baker SM, Hasnat A | title = Resistant hypertension: underlying causes and treatment | journal = Drug Research | volume = 63 | issue = 5 | pages = 217–223 | date = May 2013 | pmid = 23526242 | doi = 10.1055/s-0033-1337930 | s2cid = 8247941 }}</ref> As many as one in five people with resistant hypertension have primary aldosteronism, which is a treatable and sometimes curable condition.<ref>{{cite journal | vauthors = Young WF | title = Diagnosis and treatment of primary aldosteronism: practical clinical perspectives | journal = Journal of Internal Medicine | volume = 285 | issue = 2 | pages = 126–148 | date = February 2019 | pmid = 30255616 | doi = 10.1111/joim.12831 | s2cid = 52824356 | doi-access = free }}</ref> Resistant hypertension may also result from chronically high activity of the [[autonomic nervous system]], an effect known as neurogenic hypertension.<ref>{{cite journal | vauthors = Zubcevic J, Waki H, Raizada MK, Paton JF | title = Autonomic-immune-vascular interaction: an emerging concept for neurogenic hypertension | journal = Hypertension | volume = 57 | issue = 6 | pages = 1026–1033 | date = June 2011 | pmid = 21536990 | pmc = 3105900 | doi = 10.1161/HYPERTENSIONAHA.111.169748 }}</ref> Electrical therapies that stimulate the [[baroreflex]] are being studied as an option for lowering blood pressure in people in this situation.<ref>{{cite journal | vauthors = Wallbach M, Koziolek MJ | title = Baroreceptors in the carotid and hypertension-systematic review and meta-analysis of the effects of baroreflex activation therapy on blood pressure | journal = Nephrology, Dialysis, Transplantation | volume = 33 | issue = 9 | pages = 1485–1493 | date = September 2018 | pmid = 29136223 | doi = 10.1093/ndt/gfx279 | doi-access = free }}</ref>
[[Refractory hypertension]] is described by one source as elevated [[blood pressure]] unmitigated by five or more concurrent antihypertensive agents of different classes.<ref name="acel">{{cite journal | vauthors = Acelajado MC, Hughes ZH, Oparil S, Calhoun DA | title = Treatment of resistant and refractory hypertension | journal = Circulation Research | volume = 124 | issue = 7 | pages = 1061–1070 | date = March 2019 | pmid = 30920924 | pmc = 6469348 | doi = 10.1161/CIRCRESAHA.118.312156 }}</ref> People with refractory hypertension typically have increased sympathetic nervous system activity, and are at high risk for more severe cardiovascular diseases and all-cause mortality.<ref name=acel/><ref>{{cite journal | vauthors = Dudenbostel T, Siddiqui M, Oparil S, Calhoun DA | title = Refractory hypertension: A novel phenotype of antihypertensive treatment failure | journal = Hypertension | volume = 67 | issue = 6 | pages = 1085–1092 | date = June 2016 | pmid = 27091893 | pmc = 5425297 | doi = 10.1161/HYPERTENSIONAHA.116.06587 }}</ref>
==Epidemiology==
[[File:Hypertension World Map Men 2014.png|thumb|upright=1.5|Rates of hypertension in adult men in 2014<ref>{{cite web|title=Blood Pressure |url= https://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence/en/ |publisher=World Health Organization |access-date=22 April 2017 |url-status=live |archive-url= https://web.archive.org/web/20170418053459/http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence/en/ |archive-date=18 April 2017}}</ref>]]
[[File:Hypertensive heart disease world map - DALY - WHO2004.svg|thumb|upright=1.5|[[Disability-adjusted life year]] for [[hypertensive heart disease]] per 100,000 inhabitants in 2004:<ref name="Ref_2009">{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2009 |publisher=World Health Organization |access-date=11 November 2009 |url-status=live |archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archive-date=11 November 2009 }}</ref>
{{Col-begin}}
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{{legend|#b3b3b3|no data}}
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{{legend|#ffc600|330–440}}
{{legend|#ffb000|440–550}}
{{legend|#ff9a00|550–660}}
{{Col-break}}
{{legend|#ff8400|660–770}}
{{legend|#ff6e00|770–880}}
{{legend|#ff5800|880–990}}
{{legend|#ff4200|990–1100}}
{{legend|#ff2c00|1100–1600}}
{{legend|#cb0000|>1600}}
{{col-end}}]]
===Adults===
{{As of|2019}}, one in three or 33% of the [[world population]] were estimated to have hypertension.<ref name="WHOreport2023">{{Cite book |url=https://www.who.int/publications/i/item/9789240081062 |title=Global report on hypertension: the race against a silent killer |date=2023-09-19 |publisher=[[World Health Organization]] (WHO) |isbn=978-92-4-008106-2|___location=Geneva}}</ref><ref name="NCD2021">{{Cite journal |collaboration=NCD Risk Factor Collaboration |last1=Ezzati |first1=Majid |last2=Zhou |first2=Bin |last3=Carrillo-Larco |first3=Rodrigo M |last4=Danaei |first4=Goodarz |last5=Riley |first5=Leanne M |last6=Paciorek |first6=Christopher J |last7=Stevens |first7=Gretchen A |last8=Gregg |first8=Edward W |last9=Bennett |first9=James E |display-authors = 5 |date=2021-09-11 |title=Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants |journal=The Lancet |language=en |volume=398 |issue=10304 |pages=957–980 |doi=10.1016/S0140-6736(21)01330-1 |issn=0140-6736 |pmc=8446938 |pmid=34450083 |s2cid=237286310 |doi-access=free}}</ref> Of all people with hypertension, about 46% do not have a diagnosis of hypertension and are unaware that they have the condition.<ref name="WHO2023"/><ref name="WHOreport2023"/> In 1975, almost 600 million people had a diagnosis of hypertension, a number which increased to 1.13 billion by 2015 mostly due to risk factors for hypertension increasing in low- and middle-income countries.<ref name="WHO2023"/>
Hypertension is slightly more frequent in men.<ref name="NCD2021"/> In people aged under 50 years, more men than women have hypertension,<ref name="NCD2021"/> and in ages above 50 years the prevalence of hypertension is the same in men and women.<ref name="NCD2021"/> In ages above 65 years, more women than men have hypertension.<ref name="ESH2023"/> Hypertension becomes more common with age.<ref name=Lancet2015/> Hypertension is common in high, medium, and low-income countries.<ref name=WHO2023/><ref name="Lack2015"/> It is more common in people of low [[socioeconomic status]].<ref>{{Cite journal |last1=Leng |first1=Bing |last2=Jin |first2=Yana |last3=Li |first3=Ge |last4=Chen |first4=Ling |last5=Jin |first5=Nan |date=February 2015 |title=Socioeconomic status and hypertension: a meta-analysis |url=https://journals.lww.com/jhypertension/abstract/2015/02000/socioeconomic_status_and_hypertension__a.4.aspx |journal=Journal of Hypertension |language=en-US |volume=33 |issue=2 |pages=221–229 |doi=10.1097/HJH.0000000000000428 |pmid=25479029 |issn=0263-6352|url-access=subscription }}</ref> Hypertension is around twice as common in [[diabetic]]s.<ref>{{cite journal | vauthors = Petrie JR, Guzik TJ, Touyz RM | title = Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms | journal = The Canadian Journal of Cardiology | volume = 34 | issue = 5 | pages = 575–584 | date = May 2018 | pmid = 29459239 | pmc = 5953551 | doi = 10.1016/j.cjca.2017.12.005 }}</ref>
In 2019, rates of diagnosed hypertension were highest in Africa (30% for both sexes), and lowest in the Americas (18% for both sexes).<ref name="NCD2021" /> Rates also vary markedly within regions with country-level rates as low as 22.8% (men) and 18.4% (women) in Peru and as high as 61.6% (men) and 50.9% (women) in Paraguay.<ref name="NCD2021" />
In 1995, it was estimated that 24% of the United States population had hypertension or were taking antihypertensive medication.<ref name="pmid7875754">{{cite journal | vauthors = Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, Horan MJ, Labarthe D | title = Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991 | journal = Hypertension | volume = 25 | issue = 3 | pages = 305–313 | date = March 1995 | pmid = 7875754 | doi = 10.1161/01.HYP.25.3.305 | s2cid = 23660820 }}</ref> By 2004 this had increased to 29%<ref name="pmid7607734" /><ref name="pmid17608879">{{cite journal | vauthors = Ostchega Y, Dillon CF, Hughes JP, Carroll M, Yoon S | title = Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004 | journal = Journal of the American Geriatrics Society | volume = 55 | issue = 7 | pages = 1056–1065 | date = July 2007 | pmid = 17608879 | doi = 10.1111/j.1532-5415.2007.01215.x | s2cid = 27522876 | url = https://zenodo.org/record/1230667 }}</ref> and further to 32% (76 million US adults) by 2017.<ref name="AHA2017" /> In 2017, with the American guidelines' change in definition for hypertension, 46% of people in the United States are affected.<ref name="AHA2017" /> Some data shows African-American adults in the United States have among the highest rates of hypertension in the world at 44%.<ref name="AHA2010" /> However, other research argues there has been a "myopic perspective" on American data and notes that other groups, particularly Russians and Eastern Europeans, have markedly higher rates of hypertension than Black Americans.<ref>{{Cite journal |pmid=25426566 |date=2015 |last1=Cooper |first1=R. S. |last2=Forrester |first2=T. E. |last3=Plange-Rhule |first3=J. |last4=Bovet |first4=P. |last5=Lambert |first5=E. V. |last6=Dugas |first6=L. R. |last7=Cargill |first7=K. E. |last8=Durazo-Arvizu |first8=R. A. |last9=Shoham |first9=D. A. |last10=Tong |first10=L. |last11=Cao |first11=G. |last12=Luke |first12=A. |title=Elevated hypertension risk for African-origin populations in biracial societies: Modeling the Epidemiologic Transition Study |journal=Journal of Hypertension |volume=33 |issue=3 |pages=473-80; discussion 480-1 |doi=10.1097/HJH.0000000000000429 |pmc=4476314 }}</ref> Differences in hypertension rates are multifactorial and under study.<ref>{{cite journal | vauthors = Frohlich ED | title = Epidemiological issues are not simply black and white | journal = Hypertension | volume = 58 | issue = 4 | pages = 546–547 | date = October 2011 | pmid = 21911712 | doi = 10.1161/HYPERTENSIONAHA.111.178541 | doi-access = free }}</ref>
===Children===
Rates of high blood pressure in children and adolescents have increased in the last 20 years in the United States.<ref name="pmid19421783">{{cite journal | vauthors = Falkner B | title = Hypertension in children and adolescents: epidemiology and natural history | journal = Pediatric Nephrology | volume = 25 | issue = 7 | pages = 1219–1224 | date = July 2010 | pmid = 19421783 | pmc = 2874036 | doi = 10.1007/s00467-009-1200-3 }}</ref> Childhood hypertension, particularly in pre-adolescents, is more often secondary to an underlying disorder than in adults. Kidney disease is the most common secondary cause of hypertension in children and adolescents. Nevertheless, primary or essential hypertension accounts for most cases.<ref name=aafp>{{cite journal | vauthors = Luma GB, Spiotta RT | title = Hypertension in children and adolescents | journal = American Family Physician | volume = 73 | issue = 9 | pages = 1558–1568 | date = May 2006 | pmid = 16719248 | url = http://www.aafp.org/afp/20060501/1558.html | archive-url = https://web.archive.org/web/20070926230038/http://www.aafp.org/afp/20060501/1558.html | url-status = live | archive-date = 26 September 2007 }}</ref>
==Prognosis==
{{Main|Complications of hypertension}}
[[File:Main complications of persistent high blood pressure.svg|thumb|upright=1.4|Diagram illustrating the main complications of persistent high blood pressure]]
Hypertension is the most important [[List of preventable causes of death|preventable risk factor for premature death]] worldwide.<ref>{{cite web|title=Global health risks: mortality and burden of disease attributable to selected major risks|url=https://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf|publisher=World Health Organization|year=2009|access-date=10 February 2012|url-status=live|archive-url=https://web.archive.org/web/20120214111235/http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf|archive-date=14 February 2012}}</ref> It increases the risk of [[ischemic heart disease]],<ref name=pmid12493255>{{cite journal | vauthors = Lewington S, Clarke R, Qizilbash N, Peto R, Collins R | title = Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies | journal = Lancet | volume = 360 | issue = 9349 | pages = 1903–1913 | date = December 2002 | pmid = 12493255 | doi = 10.1016/S0140-6736(02)11911-8 | s2cid = 54363452 }}</ref> [[stroke]],<ref name="ABC"/> [[peripheral vascular disease]],<ref name="pmid18375152">{{cite journal | vauthors = Singer DR, Kite A | title = Management of hypertension in peripheral arterial disease: does the choice of drugs matter? | journal = European Journal of Vascular and Endovascular Surgery | volume = 35 | issue = 6 | pages = 701–708 | date = June 2008 | pmid = 18375152 | doi = 10.1016/j.ejvs.2008.01.007 | doi-access = free }}</ref> and other [[cardiovascular disease]]s, including [[heart failure]], [[aortic aneurysm]]s, diffuse [[atherosclerosis]], [[chronic kidney disease]], [[atrial fibrillation]], [[cancer]]s, [[leukemia]] and [[pulmonary embolism]].<ref name="Lau2017"/><ref name="ABC"/> Hypertension is also a risk factor for [[cognitive impairment]] and [[dementia]].<ref name="ABC"/> Other complications include [[hypertensive retinopathy]] and [[hypertensive nephropathy]].<ref name="JNC7"/>
==History==
{{Main|History of hypertension}}
[[File:William Harvey ( 1578-1657) Venenbild.jpg|Image of veins from Harvey's ''Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus''|left|thumb]]
===Measurement===
Modern understanding of the cardiovascular system began with the work of physician [[William Harvey]] (1578–1657), who described the circulation of blood in his book "''De motu cordis''". The English clergyman [[Stephen Hales]] made the first published measurement of blood pressure in 1733.<ref name="pmid1744849"/><ref name=Kotchen2011>{{cite journal | vauthors = Kotchen TA | title = Historical trends and milestones in hypertension research: a model of the process of translational research | journal = Hypertension | volume = 58 | issue = 4 | pages = 522–38 | date = October 2011 | pmid = 21859967 | doi = 10.1161/HYPERTENSIONAHA.111.177766 | doi-access = free }}</ref> However, hypertension as a clinical entity came into its own with the invention of the cuff-based [[sphygmomanometer]] by [[Scipione Riva-Rocci]] in 1896.<ref>{{cite book | title=A century of arterial hypertension 1896–1996 | editor=Postel-Vinay N | pages=213 | ___location=Chichester | publisher=Wiley | year=1996 | isbn=978-0-471-96788-0}}</ref> This allowed easy measurement of systolic pressure in the clinic. In 1905, [[Nikolai Korotkoff]] improved the technique by describing the [[Korotkoff sounds]] that are heard when the artery is auscultated with a stethoscope while the sphygmomanometer cuff is deflated.<ref name=Kotchen2011/> This permitted systolic and diastolic pressure to be measured.
===Identification===
Symptoms similar to those of patients with a hypertensive crisis are discussed in medieval Persian medical texts in the chapter of "fullness disease".<ref name="The medieval origins of the concept of hypertension">{{cite journal | vauthors = Heydari M, Dalfardi B, Golzari SE, Habibi H, Zarshenas MM | title = The medieval origins of the concept of hypertension | journal = Heart Views | volume = 15 | issue = 3 | pages = 96–98 | date = July 2014 | pmid = 25538828 | pmc = 4268622 | doi = 10.4103/1995-705X.144807 | doi-access = free }}</ref> The symptoms include headache, heaviness in the head, sluggish movements, general redness and warm to touch feel of the body, prominent, distended and tense vessels, a fullness of the pulse, distension of the skin, coloured and dense urine, loss of appetite, weak eyesight, impairment of thinking, yawning, drowsiness, vascular rupture, and hemorrhagic stroke.<ref name="pmid25310615">{{cite journal | vauthors = Emtiazy M, Choopani R, Khodadoost M, Tansaz M, Dehghan S, Ghahremani Z | title = Avicenna's doctrine about arterial hypertension | journal = Acta medico-historica Adriatica | volume = 12 | issue = 1 | pages = 157–162 | year = 2014 | pmid = 25310615 }}</ref> Fullness disease was presumed to be due to an excessive amount of blood within the blood vessels.
Descriptions of hypertension as a disease came, among others, from [[Thomas Young (scientist)|Thomas Young]] in 1808 and especially [[Richard Bright (physician)|Richard Bright]] in 1836.<ref name="pmid1744849"/> The first report of elevated blood pressure in a person without evidence of kidney disease was made by [[Frederick Akbar Mahomed]] (1849–1884).<ref>{{cite book |editor=Swales JD|title=Manual of hypertension |publisher=Blackwell Science |___location=Oxford |year=1995 |page=xiii |isbn=978-0-86542-861-4}}</ref>
Until the 1990s, systolic hypertension was defined as systolic blood pressure of 160 mm Hg or greater.<ref>{{Cite journal |last=Wilking |first=Spencer Van B. |date=1988-12-16 |title=Determinants of Isolated Systolic Hypertension |url=http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.1988.03410230069030 |journal=JAMA: The Journal of the American Medical Association |language=en |volume=260 |issue=23 |pages=3451–3455 |doi=10.1001/jama.1988.03410230069030 |pmid=3210285 |issn=0098-7484|url-access=subscription }}</ref> In 1993, the WHO/ISH guidelines defined 140 mmHg as the threshold for hypertension.<ref>{{Cite journal |date=1993 |title=1993 guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting. |journal=Bulletin of the World Health Organization |volume=71 |issue=5 |pages=503–517 |issn=0042-9686 |pmc=2393474 |pmid=8261554}}</ref>
===Treatment===
Historically, the treatment for what was called the "hard pulse disease" consisted of reducing the quantity of blood by [[bloodletting]] or the application of [[leech]]es.<ref name="pmid1744849">{{cite journal | vauthors = Esunge PM | title = From blood pressure to hypertension: the history of research | journal = Journal of the Royal Society of Medicine | volume = 84 | issue = 10 | pages = 621 | date = October 1991 | doi = 10.1177/014107689108401019 | pmid = 1744849 | pmc = 1295564 }}</ref> This was advocated by The [[Yellow Emperor]] of China, [[Aulus Cornelius Celsus|Cornelius Celsus]], [[Galen]], and [[Hippocrates]].<ref name="pmid1744849"/> The therapeutic approach for the treatment of hard pulse disease included lifestyle changes (staying away from anger and [[sexual intercourse]]) and dietary program for patients (avoiding the consumption of [[wine]], meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of [[spinach]] and [[vinegar]]).
In the 19th and 20th centuries, before effective pharmacological treatment for hypertension became possible, three treatment modalities were used, all with numerous side effects: strict sodium restriction (for example the [[rice diet]]<ref name="pmid1744849"/>), [[sympathectomy]] (surgical ablation of parts of the [[sympathetic nervous system]]), and pyrogen therapy (injection of substances that caused a fever, indirectly reducing blood pressure).<ref name="pmid1744849"/><ref name=Dustan>{{cite journal | vauthors = Dustan HP, Roccella EJ, Garrison HH | title = Controlling hypertension. A research success story | journal = Archives of Internal Medicine | volume = 156 | issue = 17 | pages = 1926–1935 | date = September 1996 | pmid = 8823146 | doi = 10.1001/archinte.156.17.1926 }}</ref>
The first chemical for hypertension, [[sodium thiocyanate]], was used in 1900 but had many side effects and was unpopular.<ref name="pmid1744849"/> Several other agents were developed after the [[World War II|Second World War]], the most popular and reasonably effective of which were [[tetramethylammonium chloride]], [[hexamethonium]], [[hydralazine]], and [[reserpine]] (derived from the medicinal plant ''[[Rauvolfia serpentina]]''). None of these were well tolerated.<ref>{{cite journal | vauthors = Lyons HH, Hoobler SW | title = Experiences with tetraethylammonium chloride in hypertension | journal = Journal of the American Medical Association | volume = 136 | issue = 9 | pages = 608–613 | date = February 1948 | pmid = 18899127 | doi = 10.1001/jama.1948.02890260016005 }}</ref><ref>{{cite journal | vauthors = Bakris GL, Frohlich ED | title = The evolution of antihypertensive therapy: an overview of four decades of experience | journal = Journal of the American College of Cardiology | volume = 14 | issue = 7 | pages = 1595–1608 | date = December 1989 | pmid = 2685075 | doi = 10.1016/0735-1097(89)90002-8 | doi-access = free }}</ref> A major breakthrough was achieved with the discovery of the first well-tolerated orally available agents. The first was [[chlorothiazide]], the first [[thiazide]] [[diuretic]] and developed from the antibiotic [[sulfanilamide]], which became available in 1958.<ref name="pmid1744849"/><ref>{{cite journal|vauthors=Novello FC, Sprague JM | title=Benzothiadiazine dioxides as novel diuretics | journal=J. Am. Chem. Soc. | year=1957 | volume=79 | pages=2028–2029 | doi=10.1021/ja01565a079|issue=8 | bibcode=1957JAChS..79.2028N }}</ref> Subsequently, [[beta blocker]]s, [[calcium channel blockers]], [[angiotensin converting enzyme]] (ACE) inhibitors, [[angiotensin receptor blockers]], and [[renin inhibitors]] were developed as antihypertensive agents.<ref name=Dustan />
==Society and culture==
===Awareness===
[[File:HTNstudyupd.png|thumb|upright=1.4|Graph showing the prevalence of awareness, treatment, and control of hypertension compared between the four studies of [[National Health and Nutrition Examination Survey|NHANES]]<ref name="pmid7607734">{{cite journal | vauthors = Burt VL, Cutler JA, Higgins M, Horan MJ, Labarthe D, Whelton P, Brown C, Roccella EJ | title = Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991 | journal = Hypertension | volume = 26 | issue = 1 | pages = 60–69 | date = July 1995 | pmid = 7607734 | doi = 10.1161/01.HYP.26.1.60 | url = http://hyper.ahajournals.org/cgi/pmidlookup?view=long&pmid=7607734 | url-status = dead | archive-url = https://archive.today/20121220113643/http://hyper.ahajournals.org/cgi/pmidlookup?view=long&pmid=7607734 | archive-date = 2012-12-20 | url-access = subscription }}</ref>]]
The [[World Health Organization]] has identified hypertension (high blood pressure) as the leading cause of [[cardiovascular]] [[Mortality rate|mortality]].<ref name="pmid17534457"/> [[The World Hypertension League]] (WHL), an umbrella organization of 85 national hypertension societies and leagues, recognized that more than 50% of the hypertensive population worldwide are unaware of their condition.<ref name="pmid17534457">{{cite journal | vauthors = Chockalingam A | title = Impact of World Hypertension Day | journal = The Canadian Journal of Cardiology | volume = 23 | issue = 7 | pages = 517–519 | date = May 2007 | pmid = 17534457 | pmc = 2650754 | doi = 10.1016/S0828-282X(07)70795-X }}</ref> To address this problem, the WHL initiated a global awareness campaign on hypertension in 2005 and dedicated 17 May of each year as [[World Hypertension Day]].<ref name="pmid18548140">{{cite journal | vauthors = Chockalingam A | title = World Hypertension Day and global awareness | journal = The Canadian Journal of Cardiology | volume = 24 | issue = 6 | pages = 441–444 | date = June 2008 | pmid = 18548140 | pmc = 2643187 | doi = 10.1016/S0828-282X(08)70617-2 }}</ref>
===Economics===
High blood pressure is the most common chronic medical problem prompting visits to primary health care providers in the US. The American Heart Association estimated the direct and indirect costs of high blood pressure in 2010 as $76.6 billion.<ref name = AHA2010>{{cite journal | vauthors = Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al | title = Heart disease and stroke statistics – 2010 update: a report from the American Heart Association | journal = Circulation | volume = 121 | issue = 7 | pages = e46–e215 | date = February 2010 | pmid = 20019324 | doi = 10.1161/CIRCULATIONAHA.109.192667 | doi-access = free }}</ref> In the US 80% of people with hypertension are aware of their condition, 71% take some antihypertensive medication, but only 48% of people aware that they have hypertension adequately control it.<ref name = AHA2010 /> Adequate management of hypertension can be hampered by inadequacies in the diagnosis, treatment, or control of high blood pressure.<ref name="pmid19124418">{{cite journal | vauthors = Alcocer L, Cueto L | title = Hypertension, a health economics perspective | journal = Therapeutic Advances in Cardiovascular Disease | volume = 2 | issue = 3 | pages = 147–155 | date = June 2008 | pmid = 19124418 | doi = 10.1177/1753944708090572 | s2cid = 31053059 }}</ref> [[Health care providers]] face many obstacles to achieving blood pressure control, including resistance to taking multiple medications to reach blood pressure goals. People also face the challenges of adhering to medical schedules and making lifestyle changes. Nonetheless, the achievement of blood pressure goals is possible, and most importantly, lowering blood pressure significantly reduces the risk of death due to heart disease and stroke, the development of other debilitating conditions, and the cost associated with advanced medical care.<ref name="The Economic Impact of Hypertension">{{cite journal | vauthors = Elliott WJ | title = The economic impact of hypertension | journal = Journal of Clinical Hypertension | volume = 5 | issue = 3 Suppl 2 | pages = 3–13 | date = October 2003 | pmid = 12826765 | doi = 10.1111/j.1524-6175.2003.02463.x | pmc = 8099256 | s2cid = 26799038 | doi-access = free }}</ref><ref name="pmid18345711">{{cite journal | vauthors = Coca A | title = Economic benefits of treating high-risk hypertension with angiotensin II receptor antagonists (blockers) | journal = Clinical Drug Investigation | volume = 28 | issue = 4 | pages = 211–220 | year = 2008 | pmid = 18345711 | doi = 10.2165/00044011-200828040-00002 | s2cid = 8294060 }}</ref>
==Other animals==
Hypertension in cats is indicated by a systolic blood pressure greater than 150 mmHg, with [[amlodipine]] the usual first-line treatment. A cat with a systolic blood pressure above 170 mmHg is considered hypertensive. If a cat has other problems, such as kidney disease or retina detachment, then a blood pressure below 160 mmHg may also need to be monitored.<ref>{{cite journal | vauthors = Taylor SS, Sparkes AH, Briscoe K, Carter J, Sala SC, Jepson RE, Reynolds BS, Scansen BA | title = ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats | journal = Journal of Feline Medicine and Surgery | volume = 19 | issue = 3 | pages = 288–303 | date = March 2017 | pmid = 28245741 | doi = 10.1177/1098612X17693500 | doi-access = free | pmc = 11119534 }}</ref>
Normal blood pressure in dogs can differ substantially between breeds, but hypertension is often diagnosed if systolic blood pressure is above 160 mmHg, particularly if this is associated with target organ damage.<ref name=":6">{{cite journal | vauthors = Acierno MJ, Brown S, Coleman AE, Jepson RE, Papich M, Stepien RL, Syme HM | title = ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats | journal = Journal of Veterinary Internal Medicine | volume = 32 | issue = 6 | pages = 1803–1822 | date = November 2018 | pmid = 30353952 | pmc = 6271319 | doi = 10.1111/jvim.15331 }}</ref> Inhibitors of the renin-angiotensin system and calcium channel blockers are often used to treat hypertension in dogs, although other drugs may be indicated for specific conditions causing high blood pressure.<ref name=":6"/>
== See also ==
* [[Comparison of international blood pressure guidelines]]
* [[Health effects of ultra-processed foods]]
==
{{Reflist}}
== Further reading ==
{{refbegin}}
* 2024 {{Tooltip|ESC|European Society of Cardiology}} guideline: {{Cite journal |last1=McEvoy |first1=John William |last2=McCarthy |first2=Cian P |last3=Bruno |first3=Rosa Maria |last4=Brouwers |first4=Sofie |last5=Canavan |first5=Michelle D |last6=Ceconi |first6=Claudio |last7=Christodorescu |first7=Ruxandra Maria |last8=Daskalopoulou |first8=Stella S |last9=Ferro |first9=Charles J |last10=Gerdts |first10=Eva |last11=Hanssen |first11=Henner |last12=Harris |first12=Julie |last13=Lauder |first13=Lucas |last14=McManus |first14=Richard J |last15=Molloy |first15=Gerard J |display-authors=5 |date=2024-08-30 |title=2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO) |journal=European Heart Journal |volume=45 |issue=38 |pages=3912–4018 |language=en |doi=10.1093/eurheartj/ehae178 |doi-access=free |pmid=39210715 |issn=0195-668X}}
* 2023 {{Tooltip|ESH|European Society of Hypertension}} guideline: {{Cite journal |last1=Mancia |first1=Giuseppe |last2=Kreutz |first2=Reinhold |last3=Brunström |first3=Mattias |last4=Burnier |first4=Michel |last5=Grassi |first5=Guido |last6=Januszewicz |first6=Andrzej |last7=Muiesan |first7=Maria Lorenza |last8=Tsioufis |first8=Konstantinos |last9=Agabiti-Rosei |first9=Enrico |last10=Algharably |first10=Engi Abd Elhady |last11=Azizi |first11=Michel |last12=Benetos |first12=Athanase |last13=Borghi |first13=Claudio |last14=Hitij |first14=Jana Brguljan |last15=Cifkova |first15=Renata |display-authors = 5 |date=2023-12-01 |title=2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA) |journal=Journal of Hypertension |volume=41 |issue=12 |pages=1874–2071 |doi=10.1097/HJH.0000000000003480 |issn=1473-5598 |pmid=37345492|doi-access=free |hdl=11379/603005 |hdl-access=free }}
* 2022 {{Tooltip|AAFP|American Academy of Family Physicians}} guideline: {{Cite journal |last1=Coles |first1=Sarah |last2=Fisher |first2=Lynn |last3=Lin |first3=Kenneth W. |last4=Lyon |first4=Corey |last5=Vosooney |first5=Alexis A. |last6=Bird |first6=Melanie D. |date=December 2022 |title=Blood Pressure Targets in Adults With Hypertension: A Clinical Practice Guideline From the AAFP |journal=American Family Physician |volume=106 |issue=6 |pages=Online |issn=1532-0650 |pmid=36521481}} [https://www.aafp.org/dam/AAFP/documents/journals/afp/AAFPHypertensionGuideline.pdf Key recommendations].
* 2019 {{Tooltip|NICE|National Institute for Health and Clinical Excellence}} guideline: {{Cite web |title= Hypertension in adults: diagnosis and management |url=https://www.nice.org.uk/guidance/NG136 |website=National Institute for Health and Clinical Excellence (NICE) |date=2019-08-28}}
* 2017 {{Tooltip|ACC|American College of Cardiology}}/{{Tooltip|AHA|American Heart Association}} guideline: {{Cite journal |last1=Whelton |first1=Paul K. |last2=Carey |first2=Robert M. |last3=Aronow |first3=Wilbert S. |last4=Casey |first4=Donald E. |last5=Collins |first5=Karen J. |last6=Dennison Himmelfarb |first6=Cheryl |last7=DePalma |first7=Sondra M. |last8=Gidding |first8=Samuel |last9=Jamerson |first9=Kenneth A. |last10=Jones |first10=Daniel W. |last11=MacLaughlin |first11=Eric J. |last12=Muntner |first12=Paul |last13=Ovbiagele |first13=Bruce |last14=Smith |first14=Sidney C. |last15=Spencer |first15=Crystal C. |display-authors=5 |date=2018-05-15 |title=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 |journal=Journal of the American College of Cardiology |language=en |volume=71 |issue=19 |pages=e127–e248 |doi=10.1016/j.jacc.2017.11.006|pmid=29146535 | doi-access = free}}
* 2014 {{Tooltip|JNC 8|Joint National Committee}} guideline: {{cite journal | vauthors = James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, etal | title = 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8) | journal = JAMA | volume = 311 | issue = 5 | pages = 507–20 | date = February 2014 | pmid = 24352797 | doi = 10.1001/jama.2013.284427 | doi-access = free }}
{{refend}}
{{Commons category|Hypertension}}
{{Wikivoyage|Traveling with high blood pressure|traveling with high blood pressure|information}}
{{Medical condition classification and resources
| DiseasesDB = 6330
| ICD11 = {{ICD11|BA00}}
| ICD10 = {{ICD10|I10}}
| ICD9 = {{ICD9|401}}
| OMIM = 145500
| MedlinePlus = 000468
| eMedicineSubj = med
| eMedicineTopic = 1106
| eMedicine_mult = {{eMedicine2|ped|1097}} {{eMedicine2|emerg|267}}
| MeshID = D006973
| Curlie = Health/Conditions_and_Diseases/Cardiovascular_Disorders/Hypertension/
}}
{{Vascular diseases}}
{{Portal bar|Biology|Medicine}}
{{Authority control}}
[[Category:Hypertension| ]]
[[Category:Medical conditions related to obesity]]
[[Category:Wikipedia medicine articles ready to translate (full)]]
[[Category:Wikipedia neurology articles ready to translate]]
[[Category:Articles containing video clips]]
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