What if my blood pressure is 130/90?

Normal blood pressure: Lower than 120/80 mmHg. Elevated blood pressure: Between 120-129/80 mmHg. High blood pressure, stage 1: Between 130-139/80-90 mmHg. High blood pressure, stage 2: 140/90 mmHg or higher.

While we can’t get into everything here, this article will focus on high blood pressure (hypertension) and headaches. There is a connection between the two, but it likely isn’t what you think.

First I’ll explain what hypertension is. Then I’ll discuss if high blood pressure can cause headaches, as well as treatments for headaches and when to see a doctor about head pain.

Most of the time, high blood pressure does not cause symptoms.

The only case where hypertension appears to cause a headache is with a hypertensive crisis. This occurs when blood pressure soars to 180/120 mm Hg or higher and is associated with symptoms of end organ damage. Asymptomatic hypertension (high blood pressure without any symptoms). is not a medical emergency. If you experience asymptomatic high blood pressure contact your doctor for an appointment.

Hypertensive crisis is a medical emergency, as it can lead to stroke, heart attack, kidney damage, memory loss, and other severe complications. If your blood pressure is 180/120 mm Hg or higher, wait five minutes and take your blood pressure reading again.

If your blood pressure is still elevated but you don’t have any other symptoms, contact your healthcare provider for guidance. However, if your blood pressure is 180/120 mm Hg or higher and you experience any of the below symptoms, seek emergency care immediately:

Headache happens in 20% of hypertensive urgency (serious high blood pressure with no signs or symptoms of end-organ damage) cases. Hypertensive headache feels like:

Most times, high blood pressure happens without any symptoms. But when it comes with symptoms, a person may experience:

There are many ways to treat headaches, from over-the-counter (OTC) medications to lifestyle changes to alternative therapies. While the below are safe for an otherwise healthy person, it’s important not to self-diagnose the cause of frequent or chronic head pain.

A doctor can evaluate your symptoms, health history, and other factors to properly diagnose any underlying cause of your headaches and work with you to create a treatment plan.

Two main types of medications may help alleviate different headaches:

Stress may play a role in both headaches and migraines in adults.

While stress is an everyday part of life, finding ways to manage stress can help. Consider the following:

Although some caffeine is all right and may even have positive effects on headaches, too much caffeine may trigger migraines or headaches in some people. At the same time, caffeine withdrawal—which happens when you suddenly cut back or completely give up caffeine—may also cause head pain.

If you have frequent headaches, consider how much caffeine you consume on a daily basis from beverages like coffee, soda, and tea. If you suspect caffeine may be contributing to your headaches, gradually reduce your intake.

Other treatments for headaches include:

As a bonus, these things may also help manage high blood pressure.

If you have frequent, persistent, or worsening headaches or migraines, speak with your doctor.

An occasional headache could be blamed on tiredness, stress, or hunger, but frequent headaches may be a sign of an underlying health problem. Your doctor will ask how and where you feel headache pain—whether it’s on one side of your head, both, or all around.

They may also ask what time of day you typically get them, if there’s anything that seems to help, and if you have associated symptoms such as dizziness or blurry vision. Communicating all these details to your healthcare provider will help ensure that you receive an effective treatment plan.

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Last November, the American College of Cardiology and American Heart Association issued the first new set of hypertension treatment guidelines since 2003. Overnight, some 30 million more Americans had high blood pressure.

For decades, high blood pressure in most patients was defined as 140/90 mmHg or higher (the first number measures systolic blood pressure, when the heart contracts; the second measures diastolic pressure, when the heart relaxes).

The new guidelines lower the threshold in all patients to 130/80, and the change has prompted debate among physicians in the medical literature and in the mass media.

To explain what the new guidelines mean for patients and clinicians, we talked with Andrew Moran, MD, an internist at Columbia University Irving Medical Center. Moran is the principal investigator of an NIH-funded project comparing the effectiveness and costs of U.S. national hypertension treatment guidelines. He was recently invited by JAMA Internal Medicine to comment on recent hypertension research.

The guidelines lower the threshold for a diagnosis of high blood pressure to 130/90. Why was this changed?

With the previous guidelines, hypertension was diagnosed in adults with blood pressure greater than 140/90, and treatment was aimed at reducing blood pressure in most patients to a systolic pressure below 140.

The current lower diagnostic threshold for hypertension diagnosis is justified by numerous large observational studies, which established that even people with a systolic pressure above 130 (or a diastolic pressure above 80) have an increased risk for heart disease or stroke.

The new guidelines differ from the past in recommending medication for adults with blood pressure between 130/80 and 140/90 who have any the following risk factors: diabetes, chronic kidney disease, cardiovascular disease, or a 10-year predicted cardiovascular disease risk of at least 10 percent. Medication is also recommended for adults age 65 years or older with a systolic pressure of 130 or greater. The treatment target goals are also new, with a goal of reaching below 130/80 for all adults taking antihypertensive medication. For those over 65, the goal is to achieve a systolic pressure below 130.

The new treatment guidelines were strongly influenced by the results from SPRINT (Systolic Blood Pressure Intervention Trial), which were published in 2015. The SPRINT study compared intensive treatment of hypertension (to a target systolic pressure of 120) to standard treatment (to a target of 140) in more than 9,300 patients with systolic pressure of 130 or higher and high cardiovascular disease risk. The trial found that intensive treatment reduced cardiovascular disease events and all-cause deaths compared with standard treatment.

Why do you think there’s confusion among the public and physicians about the new guidelines?

I think the hardest thing to grasp is that for low-risk, younger patients with systolic pressure between 130 and 140, medication is rarely indicated. They are given a diagnosis of hypertension, but the only recommendation is to improve diet and exercise more. The main purpose of diagnosis in that group is to notify people about their risk and motivate them to make behavior changes.

What people don’t realize when they hear about thresholds for high blood pressure is that there is a continuous relationship between blood pressure and risk for heart attack and stroke. People with naturally lower blood pressures have lower risk for these conditions. People with blood pressure of 130/90 have a higher risk than people with 120/80—even though both of those measurements were considered normal in the past. So even moderately high blood pressure (below past diagnostic thresholds) is unhealthy.

The big question for clinical practice is, does "lower is better" always apply when we lower blood pressure with drug treatment? It is not 100 percent clear. Medications can be life-saving, but too much medication may also lead to unwanted consequences, like dizziness, falls, high potassium, or kidney injury.

The strongest evidence supports intensive treatment to a lower blood pressure target in patients with a diagnosis of heart disease or stroke.

Some physicians are saying that these guidelines will lead doctors to be too aggressive with treatment. Do you think that’s true?

I don't think so. Even though hypertension diagnosis was expanded, antihypertensive treatment is not indicated for the low-risk patient with mildly elevated blood pressure.

We did see more frequent occurrences of particular serious adverse events—hypotension, fainting, electrolyte abnormalities, and acute kidney injury—in the intensive treatment arm of SPRINT. Even though SPRINT’s intensive treatment had benefits for older, frail participants, clinicians worry that the trial’s participants were healthier than the general population in other ways, meaning that we may underestimate the risk of side effects resulting from intensive blood pressure treatment.

Clinicians and patients must weigh the expected benefits and risks and decide together about whether to treat blood pressure and how intensively to treat it. For the patient with cardiovascular disease, or high risk of developing cardiovascular disease, the preponderance of evidence supports treatment with medication.

In your recent commentary in JAMA Internal Medicine, you and your co-authors wrote that it’s time to take a "precision approach" in deciding whom to treat for high blood pressure. What do you mean?

Our group estimates that up to 16.8 million U.S. adults meet the SPRINT eligibility criteria and could be considered for intensive blood pressure treatment, including 51 percent of whom are currently untreated. Intensive treatment requires more office visits, medications, and investment, and it is unclear if the U.S. health system has the capacity to deliver that much extra care.

A precision approach can help us to identify the optimal patients—those with the highest expected benefit and lowest expected risk—and prioritize them for intensive treatment. My group is starting an NIH-funded study, an ancillary study to SPRINT called “Optimize SPRINT,” to develop a method for identifying these patients.

As you mentioned above, we often hear that only half of people with hypertension know they have it, and many of those who know it don’t have it controlled. Has this gotten better over time? Are there any disturbing trends?

As we consider lower blood pressure thresholds for starting medication and investment in intensive blood pressure treatment in high-risk adults, it is important to take stock of how we are doing in terms of achieving the old “standard” goal of 140/90 mmHg.

It is a sobering fact that in the most recent U.S. survey (2015-2016), less than half of patients with hypertension had their blood pressure controlled to under 140/90. That is a reversal, since over 50 percent had achieved control from 2009-2014.