Uncontrolled High Blood Pressure (Established)

Image of a woman taking a man's blood pressure using a manual blood pressure cuff.

Your blood pressure was unusually high today. Your blood pressure may be high for several reasons. For example, this can occur if you’ve missed doses of your blood pressure medicine. Or it can happen if you are taking other medicines such as some asthma inhalers, decongestants, diet pills, and illegal drugs like cocaine and amphetamine.

Other causes of high blood pressure include:

  • Weight gain

  • Too much salt in your diet

  • Smoking

  • Caffeine

  • Lack of exercise

  • Intense pain

  • Becoming upset—this means you feel fear, anger, or another strong emotion

Blood pressure measurements are given as two numbers. Systolic blood pressure is the upper number. This is the pressure when the heart contracts. Diastolic blood pressure is the lower number. This is the pressure when the heart relaxes between beats. You will see your blood pressure readings written together. For example, a person with a systolic pressure of 118 and a diastolic pressure of 78 will have 118/78 written in the medical record. To be diagnosed with high blood pressure, your numbers must be higher than the normal range when tested over a period of time.

Blood pressure is categorized as normal, elevated, or stage 1 or stage 2 high blood pressure:

  • Normal blood pressure is systolic of less than 120 and diastolic of less than 80 (120/80)

  • Elevated blood pressure is systolic of 120 to 129 and diastolic less than 80

  • Stage 1 high blood pressure is systolic of 130 to 139 or diastolic between 80 to 89

  • Stage 2 high blood pressure is when systolic is 140 or higher or the diastolic is 90 or higher

Uncontrolled high blood pressure can cause serious health problems. It raises your risk for heart attack, stroke, as well as both kidney and heart failure. But you can do many things to manage your blood pressure. In general, if you have high blood pressure, keeping your blood pressure below 130/80 mmHg may help prevent these problems. Your healthcare provider may prescribe medicine to help control blood pressure if lifestyle changes are not enough.

Home care

It’s important to take steps to lower your blood pressure. If you are taking blood pressure medicine, the guidelines below may help you need less or no medicines in the future.

  • Start a weight-loss program if you are overweight.

  • Cut back on the amount of salt in your diet:

    • Don't have high-salt foods such as olives, pickles, smoked meats, canned soups, deli meats, or salted potato chips.

    • Don’t add salt to your food at the table.

    • Use only small amounts of salt when cooking.

  • Start an exercise program. Talk with your healthcare provider about what exercise program is best for you. It doesn’t have to be difficult. Even brisk walking for 20 minutes 3 times a week is a good form of exercise.

  • Don't use medicines that stimulate the heart. This includes many over-the-counter cold and sinus decongestant pills and sprays, as well as diet pills. Check the warnings about high blood pressure on the label. Before purchasing any over-the-counter medicines or supplements, always ask the pharmacist about the product's potential interaction with your high blood pressure and your medicines.

  • Stimulants such as amphetamine or cocaine could be lethal for someone with high blood pressure, as well as those on certain blood pressure medicines. Never take these.

  • Limit how much caffeine you drink. Consider switching to noncaffeinated beverages.

  • Stop smoking. If you are a long-time smoker, this can be hard. Enroll in a stop-smoking program to make it more likely that you will succeed. Talk with your provider about ways to quit.

  • Learn how to handle stress better. This is an important part of any program to lower blood pressure. Learn ways to relax. These include meditation, yoga, and biofeedback.

  • If medicines were prescribed, take them exactly as directed. Missing doses may cause your blood pressure to get out of control. Don't stop taking your medicines, even if you feel better or you feel like you don't need them anymore. Talk with your healthcare provider.

  • If you miss a dose or doses of your medicines, check with your healthcare provider or pharmacist about what to do.

  • Consider buying an automatic blood pressure machine. Your provider may advise a certain type. These are available at most pharmacies. It's ideal to measure your blood pressure twice a day, once in the morning, and once in the late afternoon. Try to be consistent. Check your blood pressure around the same time each day for a good comparison. Keep a written record of your home blood pressure readings and take the record to your medical appointments.

Here are some other guidelines on home blood pressure monitoring from the American Heart Association.

  • Don't smoke or drink coffee for 30 minutes before measuring your blood pressure.

  • Go to the bathroom before the test.

  • Relax for 5 minutes before taking the measurement.

  • Sit correctly. Be sure your back is supported. Don't sit on a couch or soft chair. Uncross your feet and place them flat on the floor. Place your arm on a solid, flat surface like a table with the upper arm at heart level. Make certain the middle of the cuff is directly above the bend of the elbow. Check the monitor's instruction manual for an illustration.

  • Take multiple readings. When you measure, take 2 or 3 readings 1 minute apart and record all of the results.

  • Take your blood pressure at the same time every day, or as your healthcare provider recommends.

  • Record the date, time, and blood pressure reading.

  • Take the record with you to your next appointment. If your blood pressure monitor has a built-in memory, simply take the monitor with you to your next appointment.

  • Call your provider if you have several high readings. Don't be frightened by a single high reading, but if you get several high readings, check in with your healthcare provider.

  • Note: When blood pressure reaches a systolic (top number) of 180 or higher or a diastolic (bottom number) of 110 or higher, you need emergency medical treatment. Call your healthcare provider right away.

Follow-up care

Regular visits to your own healthcare provider for blood pressure and medicine checks are an important part of your care. Make a follow-up appointment as directed. Bring the record of your home blood pressure readings to the appointment.

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Blood pressure reaches a systolic (top number) of 180 or higher or diastolic (bottom number) of 110 or higher— emergency medical treatment is required

  • Throbbing or rushing sound in the ears

  • Nosebleed that comes back or doesn't go away

  • Dizziness or dizziness with spinning sensation (vertigo)

Call 911

Call 911 if any of these occur:

  • Chest, arm, shoulder, neck, or upper back pain

  • Shortness of breath

  • Severe headache

  • Extreme drowsiness, confusion, or fainting

  • Weakness, tingling, or numbness of your face, arms, or legs (especially on one side of the body)

  • Trouble speaking or seeing 

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