When Should You Go to the ER for Blood Pressure?

Risk factors for developing high blood pressure include:

• Family history 
• Gender 
  • Up to age 64, men are more likely to develop high blood pressure than women 
  • At age 65 and older, women are more likely to develop high blood pressure than men
• Race: African-Americans tend to develop high blood pressure more frequently than people of other races in the U.S.
• Age 
• Sedentary lifestyle
• Being overweight or obese    
• Unhealthy diet, particularly one high in salt (sodium), calories, saturated and trans fats, and sugar
• Excess alcohol intake
• Untreated obstructive sleep apnea 
• Diabetes
• High cholesterol
• Smoking and tobacco use  
• Stress 

Causes of low blood pressure include: 

• Some medications
  • Diuretics and other drugs used to treat high blood pressure 
  • Heart medications such as beta blockers
  • Erectile dysfunction drugs (especially when combined with nitroglycerine)
  • Parkinson's disease medications
  • Tricyclic antidepressants
  • Narcotics
  • Alcohol
• Decreased blood volume, which can be caused by dehydration, major trauma, and severe internal bleeding or anemia
• Prolonged bed rest
• Pregnancy
• Older age
• Heart problems
• Endocrine problems
• Autonomic nervous system disorders, such as Parkinson’s disease 
• Nutritional deficiencies, including low levels of vitamins B-12 and folic acid 
• Neurally mediated hypotension, a disorder that causes blood pressure to drop after standing for long periods
• Severe infection (septic shock)
• Severe allergic reaction (anaphylaxis)

Blood pressure is measured with a pressure cuff (sphygmomanometer). The cuff is placed around the upper arm and then manually or electronically inflated. When it is inflated the cuff compresses the brachial artery, the major blood vessel of the upper arm, briefly stopping blood flow. The air in the cuff is then released slowly while the person performing the measurement listens with a stethoscope or monitors an electronic readout.

Blood pressure is expressed in two numbers: 

• Systolic blood pressure (the first/top number): measures the pressure in the blood vessels when the heart beats
• Diastolic blood pressure (the second/bottom number): measures the pressure in the blood vessels when the heart is at rest between beats

These measurements can tell if your blood pressure is normal, high, or low. 

• High blood pressure (hypertension) is 140/90 mmHg or more
• Elevated blood pressure levels between 120/80 and 139/89 are considered prehypertension and mean a person is at higher risk for developing high blood pressure
• Normal blood pressure is less than 120/80 mmHg 

Adults 20 years of age and older should have their blood pressure checked during regular doctor visits.

Lifestyle modifications are often the first line treatment for high blood pressure. These include: 

• Eating a healthy, balanced diet low in salt
• Limiting or avoiding alcohol
• Exercising regularly
• Managing stress
• Maintaining a healthy weight
• Not smoking
• Getting adequate sleep
• Taking medications as directed

When medications are needed to treat high blood pressure, they may include: 

• ACE inhibitors
• Beta-blockers
• Calcium channel blockers
• Peripherally acting alpha-adrenergic blockers
• Angiotensin II antagonists
• Vasodilators
• Centrally-acting alpha adrenergics
• Renin inhibitors
• Combination medicines
• Diuretics (“water pills”)

It is not always necessary to treat low blood pressure, especially if it does not cause bothersome symptoms. When symptoms of low blood pressure occur, treatment depends on the symptoms. 

Lifestyle changes to fix low blood pressure may include: 

• Drinking more fluids
• Changing what and how you eat 
• Changing how you sit and stand up
• Compression stockings 

Medical intervention to fix low blood pressure may include: 

• Medication to raise blood pressure
• Intravenous fluids like saline
• Adjusting medicines that cause low blood pressure (never change the dose or regimen of a prescribed medication without first talking to your doctor)