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Blood pressure is the force of blood pushing against the blood vessel walls. High blood pressure, or hypertension, affects 9 of 10 Americans older than 50 years; anyone reading this is at risk. Hypertension can cause heart attacks, strokes, kidney failure, and heart failure. Usually, people with high blood pressure feel fine until one of these conditions occur. Therefore, prevention should be a top health priority.

Blood pressure is recorded as 2 numbers. The top number is the systolic pressure when the heart beats, and the bottom number is the diastolic pressure when the heart rests. Hypertension may be present if the top number is greater than 140 or the bottom number is greater than 90. But it is the top number that matters most because it lines up best with risks of heart disease.

Blood pressure is measured using a simple cuff that can be found everywhere. But the best measurement, especially if you already have hypertension, is at home with your own device. Your device should be checked against your physician’s measurement in the office.

The answer depends on your health. From the Systolic Blood Pressure Intervention Trial (SPRINT), we know that for patients with other reasons to have heart disease (such as obesity, abnormal cholesterol, or older age), treating high blood pressure to a level of approximately 120/80 mm Hg saves lives and prevents heart failure. However, a pressure as low as 120/80 mm Hg may not be a good goal for everyone. And in those without other risk factors for heart disease, getting the blood pressure to less than 140/90 mm Hg may be a preferred fit. This higher goal may also be good for those with adverse effects related to blood pressure medicines and could be safer. There is still debate among experts about the right numbers for each person. Discuss your risks for heart disease with your physician and jointly consider your treatment goals.

Ultimately, the goal is to get the blood pressure back to levels that will lower the chances of having heart, brain, and kidney problems. Treatment first includes lifestyle change. Prescription drugs are not always needed. Healthy lifestyle changes include exercising regularly (walking fast for 40 minutes per day, 3-4 times per week), losing weight, and eating a diet that has whole grains (fiber)/fruits/vegetables, is low in salt, and is low in saturated fat. Stopping tobacco use and cutting back on the amount of alcohol will also lower blood pressure.

If prescription drugs are needed, these drugs are usually effective, mostly well-tolerated, and available as inexpensive generic medications. The main blood pressure drugs fit into several groups, often used in combination with each other. You should discuss with your clinician the best drugs for you. Once your blood pressure lowers with lifestyle and medications, it is important to keep up healthy habits, including taking your medications, and checking your blood pressure regularly.

Treating high blood pressure should not be ignored. By working with your clinician, you can come up with a good plan that will lower your blood pressure, keep up your health, and prevent heart attacks, heart failure, and strokes.

Published Online: November 8, 2017. doi:10.1001/jamacardio.2017.4126

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e146-e603.

James PA, Oparil S, Carter BL, et al. 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). JAMA. 2014;311(5):507-520.