Managing High Blood Pressure
Frequently Asked Questions: Women's Health
Blood pressure is the force of blood pushing against the walls of the blood vessels called arteries. The arteries carry blood from your heart to your lungs, where the blood picks up oxygen, which is delivered to your organs and tissues. The organs and tissues use the oxygen to power their activities. Other blood vessels called veins bring the now oxygen-poor blood and waste products back to the heart and lungs.
You should have your blood pressure measured at least every 2 years if your blood pressure is normal and more often if it is higher than normal.
A cuff with a balloon inside is wrapped around your upper arm. Air is pumped into the balloon. Your pressure reading is taken while the cuff is squeezing your arm.
Your blood pressure reading has two numbers. Each number is separated by a slash: 110/80, for instance. You may hear this referred to as “110 over 80.” The first number is the pressure against the artery walls when the heart contracts. This is called the systolic blood pressure. The second number is the pressure against the artery walls when the heart relaxes between contractions. This is called the diastolic blood pressure.
Blood pressure can go up and down. It goes down when you sleep and goes up when you are active or nervous. This is normal. Your blood pressure is the average of several readings taken on different occasions.
A blood pressure reading is classified into one of five categories: normal, elevated, stage 1 hypertension, stage 2 hypertension, and hypertensive crisis. Recognizing elevated blood pressure is important. If you have elevated blood pressure, you often can make lifestyle changes to prevent the development of hypertension.
Long before high blood pressure causes symptoms, it can damage vital organs in your body:
- Blood vessels—Long-term high blood pressure can damage the walls of the arteries. Damaged artery walls are more likely to attract a sticky substance called plaque. Plaque can build up inside blood vessel walls and, over time, cause the arteries to narrow and harden. This condition is called atherosclerosis. The combination of atherosclerosis and high blood pressure sets the stage for a stroke or heart attack.
- Heart—As blood pressure increases, the heart has to work harder to deliver oxygen to the tissues. Over time, the heart may enlarge. Its walls may thicken or thin. The heart may no longer pump efficiently enough to keep up with the body’s demands. Tissues become starved of oxygen, causing fatigue, breathing problems, and weakness.
- Brain—High blood pressure can cause a blood vessel in the brain to become blocked, cutting off oxygen to that part of the brain. A blood vessel also can burst. This is called a stroke. During a stroke, cells in that part of the brain may die. A stroke can cause permanent brain damage or death.
- Kidneys—The kidneys filter the blood to remove wastes from your body. The blood vessels in the kidneys can be damaged easily by high blood pressure. When the kidneys are not working normally, their ability to control salt and water balance in the body is disrupted. This can lead to kidney failure.
- Eyes—High blood pressure can cause the blood vessels in your eyes to constrict. This can cause vision problems and may even lead to blindness.
The following factors that increase the risk of high blood pressure cannot be changed:
- Age—Blood pressure increases with age.
- Race—High blood pressure is more common in African Americans than in any other racial group.
- Family history—High blood pressure tends to run in families.
- Medical conditions—Certain diseases, such as diabetes mellitus and kidney disease, increase the risk of high blood pressure.
- History of preeclampsia
Lifestyle habits also can affect blood pressure. These are things you can change. You are at greater risk of high blood pressure if you
- are overweight
- are not physically active
- smoke cigarettes
- drink more than two alcoholic drinks per day
- eat a poor diet (too much fat, not enough fruits and vegetables)
- eat too much salt
Adopting certain lifestyle habits can decrease your risk of developing high blood pressure in the future:
- Quit smoking.
- Lose weight if you are overweight.
- Limit your intake of alcohol.
- Exercise regularly.
- Cut back on salt.
- Change your diet—The DASH (Dietary Approaches to Stop Hypertension) eating plan focuses on heart-healthy foods. To find out more about DASH, go to www.nhlbi.nih.gov/health/resources/heart/hbp-dash-index.
- Relieve stress.
If lifestyle changes alone do not lower your blood pressure, medications usually are recommended. Many types of medications are available that work in different ways. It is important to continue taking your medication even when you are feeling healthy. It also is important to continue your healthy lifestyle habits even if taking medication lowers your blood pressure readings into the healthy range.
High blood pressure during pregnancy can cause serious problems, including growth problems with the fetus, preterm birth, and worsening of any preexisting conditions that you have because of high blood pressure. If you have chronic (long-lasting) high blood pressure and are planning to become pregnant, see your health care professional for a prepregnancy check-up. This will give you a chance to stabilize your blood pressure and to become as healthy as possible. During pregnancy, your blood pressure will be measured often. You will be monitored for signs and symptoms of preeclampsia. You may have special tests to monitor the well-being and growth of the fetus.
High blood pressure that first occurs in the second half (after 20 weeks) of pregnancy is called gestational hypertension. Management depends on how high your blood pressure is. Most women with gestational hypertension have only a mild increase in blood pressure. Some women, however, develop severe hypertension and are at risk of serious complications. All women with gestational hypertension are monitored closely to make sure their blood pressure does not go too high and to look for signs of preeclampsia.
Preeclampsia is a serious high blood pressure disorder that can occur during pregnancy and in the weeks after pregnancy. If it is not diagnosed and managed, it can cause severe complications in both the woman and her fetus. Women who have had preeclampsia have an increased risk of developing high blood pressure and cardiovascular disease later in life.
Some birth control methods are not recommended for women with high blood pressure. These methods include the following:
- Combined hormonal birth control methods—These methods contain estrogen and progestin and include the combined hormonal pill, patch, and ring. If you are being treated for high blood pressure—even if your blood pressure is normal—discuss the use of these methods with your health care professional.
- Injection—This form of birth control should not be used by some women with high blood pressure. Talk with your health care professional if your blood pressure is above normal.
Blood pressure usually does not change much with hormone therapy. In some women, hormone therapy actually decreases blood pressure. In others, some types of hormone therapy increase blood pressure. Because the effects of hormone therapy on blood pressure are not predictable, all women who are taking hormone therapy should have their blood pressure checked more often.
Atherosclerosis: Narrowing and clogging of the arteries caused by a buildup of plaque. Also called hardening of the arteries.
Cardiovascular Disease: Disease of the heart and blood vessels.
Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.
Diastolic Blood Pressure: The force of the blood in the arteries when the heart is relaxed. It is the lower reading when blood pressure is taken.
Fetus: The stage of human development beyond 8 completed weeks after fertilization.
Gestational Hypertension: High blood pressure that is diagnosed after 20 weeks of pregnancy.
Heart Attack: Damage to part of the heart muscle that occurs when its blood supply is interrupted. A heart attack almost always is caused by narrowing or blockage of the blood vessels in the heart.
Hormone Therapy: Treatment in which estrogen and often progestin are taken to help relieve symptoms that may happen around the time of menopause.
Oxygen: An element that we breathe in to sustain life.
Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.
Preterm: Less than 37 weeks of pregnancy.
Stroke: A sudden interruption of blood flow to all or part of the brain, caused by blockage or bursting of a blood vessel in the brain. A stroke often results in loss of consciousness and temporary or permanent paralysis.
Systolic Blood Pressure: The force of the blood in the arteries when the heart is contracting. It is the higher reading when blood pressure is taken.
If you have further questions, contact your obstetrician–gynecologist.
FAQ123. Copyright October 2018 by the American College of Obstetricians and Gynecologists
This information is designed as an educational aid to patients and sets forth current information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. Read ACOG’s complete disclaimer.