High blood pressure (hypertension)

Hypertension is another way of saying high blood pressure. When your heart beats, it pumps blood out of your heart and into your blood vessels to nourish your body. Your blood pressure reading measures the force of your blood pushing against your artery walls when the heart contracts and rests. The systolic pressure (the top number) describes the pressure when your heart beats and the muscle contracts, and the diastolic pressure (bottom number) describes the pressure in your arteries between heartbeats, as the heart rests and fills with blood. You have hypertension when you have a systolic reading of 140 or above and a diastolic reading of 90 and above.

Penn Medicine is a leader in the diagnosis, management, and treatment of high blood pressure. We use advanced approaches to accurately assess your condition, determine underlying causes, and develop a personalized treatment plan.

High blood pressure damages the artery walls, causing them to become thinned and stretched. Hypertension can cause a wide range of complications, including:

• Vascular weakness: When blood vessels are stretched too thin, they are more prone to rupture, causing strokes and aneurysms.
• Blood clots: Damage to the artery walls can increase the risk of blood clots forming. If a clot blocks blood flow to the heart or brain, it can cause a heart attack or stroke.
• Vascular scarring: When the thin artery walls tear, scar tissue can build up on the walls of the arteries and veins
• Plaque build-up: Plaque or cholesterol deposits can collect in the arteries where there is scar tissue. This can block blood flow, making your heart work harder. Plaque can also break off and block the flow altogether, leading to heart attacks and strokes.

Most people do not know they have high blood pressure until it is detected during a routine checkup or blood pressure screening. When blood pressure becomes severely elevated, symptoms may include headache, shortness of breath, chest pain, vision changes, or confusion. Regular blood pressure checks are important for identifying hypertension early and helping prevent serious complications such as heart attack, stroke, and kidney disease.

Hypertension usually develops slowly over time. If hypertension runs in your family, if you don't maintain a proper diet, are overweight, or are over 60, you are at greater risk for high blood pressure. Race also plays a role, as African Americans are more likely to have high blood pressure. Some other risk factors include:

• Smoking
• Too much alcohol consumption
• A diet heavy in sodium
• Not enough Vitamin D or potassium in your diet
• Oral contraception use
• Stress
• Kidney disease
• Diabetes
• Sleep apnea

Diagnosing high blood pressure typically involves taking multiple blood pressure measurements over time. Your care team may use readings taken in the office, at home, or with a wearable or ambulatory blood pressure monitor to confirm a diagnosis and understand how your blood pressure changes throughout the day. Your doctor may also order blood and urine tests as well as imaging tests to identify factors contributing to high blood pressure and assess whether it has affected your heart, kidneys, or other organs.

Treatment is focused on lowering your blood pressure and reducing your risk of heart attack, stroke, kidney disease, and other complications. Your treatment plan may include lifestyle changes, medication, or a combination of approaches. If your blood pressure is difficult to manage, your Penn Medicine care team may evaluate you for an underlying cause and recommend specialized treatment.