Symptoms

Hypertension is often referred to as the “silent killer” because it often causes no symptoms (regardless of the stage) unless dangerous complications develop. High blood pressure puts you at risk for other serious conditions such as:

• Heart attack, which may cause chest pain or shortness of breath
• Heart failure, which may cause swelling, fatigue, and trouble breathing
• Stroke, which may cause headache, weakness, paralysis, or blurry vision
• Chronic kidney disease and kidney failure, which may cause elevated levels of creatinine in the blood, higher levels of white and red blood cells, and protein in the urine

Causes

Primary hypertension doesn’t have a single, clear cause. Usually, many factors come together to cause it. Common causes include:

• Unhealthy eating patterns (including a diet high in sodium).
• Lack of physical activity.
• High consumption of beverages containing alcohol.

Secondary hypertension has at least one distinct cause that healthcare providers can identify. Common causes of secondary hypertension include:

• Certain medications, including immunosuppressants, NSAIDs and oral contraceptives (the pill).
• Kidney disease.
• Obstructive sleep apnea.
• Primary aldosteronism (Conn’s syndrome).
• Recreational drug use (including amphetamines and cocaine).
• Renal vascular diseases, which are conditions that affect blood flow in your kidneys’ arteries and veins. Renal artery stenosis is a common example.
• Tobacco use (including smoking, vaping and using smokeless tobacco).

Treatments

High blood pressure treatments include lifestyle changes and medications. Healthcare providers recommend treatment based on your blood pressure readings, the causes of your high blood pressure and your underlying conditions.

Lifestyle changes to lower your blood pressure

You may be wondering if you can lower your blood pressure naturally. Yes, in some cases, it’s possible to lower your blood pressure without medication. For example, your provider may recommend starting with lifestyle changes if you have elevated blood pressure or stage 1 hypertension.

Here are some proven ways to lower your blood pressure naturally:

• Keep a weight that’s healthy for you. Your healthcare provider can give you a target range.
• Eat a healthy diet. An example is the DASH diet. This is a way of eating that’s full of fruits, vegetables, whole grains and low-fat dairy.
• Cut down on salt. Ideally, limit your sodium intake to no more than 1,500 milligrams (mg) per day. If this is too difficult at first, you can start by reducing your daily intake by at least 1,000 milligrams.
• Get enough potassium. Try to consume 3,500 to 5,000 milligrams per day, ideally through the foods you eat rather than supplements. Some foods high in potassium include bananas, avocados and potatoes (with skin).
• Exercise. Ask your healthcare provider for tips to get started. In general, start slow and work your way up to 150 minutes of aerobic exercise per week. Resistance training (like lifting light weights) is also helpful.
• Limit alcohol. If you choose to drink beverages containing alcohol, do so in moderation.

Sometimes, providers recommend lifestyle changes along with medications to lower your blood pressure.

Medications to lower your blood pressure

Four classes of blood pressure medications are “first-line” (most effective and commonly prescribed) when starting treatment:

• Angiotensin-converting enzyme (ACE) inhibitors block the production of the angiotensin II hormone, which the body naturally uses to manage blood pressure. When the medicine blocks angiotensin II, your blood vessels don’t narrow.
• Angiotensin II receptor blockers (ARBs) block this same hormone from binding with receptors in the blood vessels. ARBs work the same way as ACE inhibitors to keep blood vessels from narrowing.
• Calcium channel blockers prevent calcium from entering the muscle cells of your heart and blood vessels, allowing these vessels to relax.
• Diuretics (water or fluid pills) flush excess sodium from your body, reducing the amount of fluid in your blood. People often take diuretics with other high blood pressure medicines, sometimes in one combined pill.

Your provider may couple other medications with these first-line drugs to better manage your blood pressure.