Published by: Ingrid King. Last Updated on: July 25, 2023 by Crystal Uys
Feline hypertension, the medical term for high blood pressure, is usually seen in older cats, and is most often secondary to an already existing disease such as kidney failure, heart disease, or hyperthyroidism. Accurate diagnosis and treatment are important to prevent serious consequences.
Signs
High blood pressure is known as the silent killer, because by itself, it has no symptoms. High blood pressure causes wear and tear on the heart and kidneys. It can cause small blood vessels to leak and rupture. If this happens in the eye, it can lead to blindness. If it happens in the brain, it can lead to a stroke.
Diagnosis
Obtaining an accurate blood pressure measurement on cats can be challenging. Most cats are stressed when they visit the vet, and stress elevates blood pressure. There’s even a name for this in human medicine: “white coat syndrome.” This is a phenomenon in which patients exhibit elevated blood pressure in a clinical setting, but not in other settings, and it applies to cats as well.
Blood pressure in cats is measured the same way it is measured in humans: with an inflatable cuff and an ultrasonic listening device called a Doppler. In order to minimize stress during this non-invasive test, it helps if it is done in a quiet room, away from barking dogs and other noises. Usually, having the cat’s guardian present can help calm the cat. The vet will take several readings, to rule out the above mentioned white coat effect as much as possible.
If blood pressure is consistently high after taking several measurements, additional tests will be necessary, including, at a minimum, a complete bloodcount, blood chemistry, and urinalysis.
Risk Factors
Cats who have one or more of the following conditions are at risk for elevated blood pressure:
- Hyperthyroidism
- Chronic renal failure and other kidney disease
- Diabetes
Treatment
The decision whether to treat hypertension should be based on reliable, repeatable blood pressure readings, and will be influenced by any concurrent disease. Vets must take the cat’s temperament and anxiety level into consideration when interpreting blood pressure test results. Normal cats often have transient elevated blood pressure due to the stress of being at the vet’s and the exam itself. The treatment decision will also depend on an individual cat’s risk factors.
Treatment will first target the underlying disease. Medications that can exacerbate hypertension, such as steroids, will need to be eliminated or reduced. Excessive sodium in the diet should be avoided, but a low salt diet is not necessarily indicated. Maintaining normal potassium levels is important, and a low salt diet can lead to loss of potassium without any beneficial effects on blood pressure.
If treatment is indicated, the type of drug used will depend on the overall diagnosis. The goal of treatment is to reduce blood pressure into a range that minimizes organ damage. Once blood pressure is controlled, it should be rechecked every three months.
Cats in a hypertensive crisis (severe neurological symptoms or sudden onset blindness) will need emergency treatment and will usually require hospitalization and careful monitoring. The prognosis for these cats is variable. Some cats with sudden onset blindness will recover some of their lost vision if treatment is initiated soon enough.
The American Association of Feline Practitioners recommends blood pressure monitoring as part of a regular bi-annual senior cat exam in their Senior Care Guidelines.
Featured Image Credit: Hananeko, Shutterstock
About the author
Ingrid King is an award-winning author, former veterinary hospital manager, and veterinary journalist who is passionate about cats.
Ingrid, I am so grateful for reading your article! I have noticed our Phoebe’s eye sight isn’t as sharp as it used to be. 11 years of sharing our lives together I notice changes in her activities such as mistepping or misjudged jumps. Specially at night or its darker in the room she’s in. Her physical, blood work & urine all came back fine. She got her teeth cleaned and a few teeth pulled. I’m going to make an appt to have her BP taken. I looked through her records and don’t see anything about BP. I can’t believe I never thought to ask or if I assumed they do it as part of her physical. Thank you for the information and to your wonderful readers for commenting thier personal stories. It had been an eye opener
I’m glad the information is helpful to you, Angela. I hope everything turns out to be normal with Phoebe’s BP, and what you’re seeing are just normal aging changes.
Skyrocketed blood pressure! My 15-year-old Siamese kitty was diagnosed with early-stage chronic kidney disease. We are working with that.
Secondarily, about 6 weeks ago she had a neuro event which looked like either a stroke or brain bleed. It left her very weak and disoriented, with limited use of her left legs, both front and mostly rear. We have worked with her extensively, and her recovery has amazed both us and our vets.
But part of her post-event workup has been blood pressure. Two days after her neuro event, when she was still very fragile, her BP at vets (following a nerve-wracking transport in her travel crate in the car) was 180, at the very high end of safe. After a month when her BP was retaken, she was so crazed about another car trip to the vet, being handled by strangers, then held down, her BP was in the low 200’s. And this week, it was 235!
There is considerable concern about it being a result of the CKD, but more likely she has worked herself into a frenzy at the car transport, being where there are dogs barking, being handled by strangers (she is NEVER around other people), and being held down with a cuff on her leg.
We have tried to minimize the stimulants, but we are unsuccessful.
We are all very concerned that with her BP being so high, that it could easily trigger another neuro event. I would be devastated if I thought that I could have caused that.
Both the vets and I have decided to go ahead and put her on BP medication. I’m fine with that. But I feel very concerned that 1- since there was no way to properly determine her BP, we will not know how to titre the meds to determine how much she really needs (more or less), and 2- the possibility of quality of life issues.
When she is home, she is very calm. During the day, she sleeps all but about 2.5 hours. She’s 15 (you’d never know it to look at her). She earned the right to snooze as much as she wishes.
I am open to any suggestions about how to get an accurate BP measurement. Here’s what we have tried:
1- Transport – tried to make it as quick as possible. It’s about 20 minutes in car, and by arrival, she has worked herself into a howling frenzy. in the vet’s office, tried to limit noise and light, her mommy (whom she trusts) holding and soothing her. But her anxiety just escalated at being handled and held down by strangers.
2- Purchasing a BP monitor, and taking it in the calm of her home. Those found on Amazon are not rated well at all. Vet will not loan their out.
3- Having a mobile vet come to our home – take BP in the van, or even in our home. But we know our kitty – as already evidenced, she will go ballistic about being handled by a stranger – not only in our home, but especially in a vehicle.
I’m in the desperation mode here. Open to thoughts, suggestions, recommendations. Help!
I would contact lapoflove.com and see if they have a geriatric care vet in your area. If yes, I would pay them to come to the home and teach you how to put the little cuff on and read her pressure. They should be willing to do this. I think Ingrid has used their nutritionists. Also, the cuff should be a tiny cat cuff—some vets have only bigger ones. They have vets in most states. We used Dr Aimee Vasse through them. I wish we had known about them and their geriatric in home care and switched to them for the last few years of our beloved cat’s life. Good luck.
This is an excellent article for all cat owners to read.
My cat, Jabberwoky Glitter, has chronic kidney disease, hyperthyroidism, asthma and hypertension. She’s on Amlodipine compounded for her in a yummy medium, I’m guessing it tastes like tuna. I periodically borrow the device to measure her bp at home though the readings were the same in the clinic because she is a pretty calm cat.
Thanks for bringing up this subject for everyone!
What is the yummy medium? Compounded by you or your vet or pharmacist? Thanks!
It is compounded by the pharmacy which is Specialty Veterinary Pharmacy. Not sure what it is but Glitter just loves it. I use it as a treat after she gets her felimazole.
Just an FYI related to compounding drugs for cats – I have a high blood pressure medication, appetite stimulant and antacid compounded into a cream for my cat. I rub it on the hairless part of her ear. This is a million times easier than giving her a pill(s).
Where do you get your compounding done Mark?
I have not been successful in getting a blood pressure reading from the tail. So I use a front leg to get a reading.
My vet has never taken either of my cats’ BP. What is the general practice among vets?
Unless you specifically ask about it, most vets won’t bring it up. And there are still a significant number of vets who still do not have the equipment. And this is despite information coming out that shows how important it is to track BP in cats (and dogs.)
As mentioned in the article, the AAFP recommends it as standard of care for senior cats. Unfortunately, far too many vets still don’t do it, or don’t even have the equipment to do it.
I’ve been working at various vet hospitals since 2010 – not a single one routinely takes BP. Not even the specialists do it – I had one of my cats to see an internist a little while ago and had actually specifically asked to have his BP taken (because I am well aware of the risks – my last cat wasn’t diagnosed until she went blind…) and it wasn’t done.
It’s a shame, but from my own experience at work, it is also almost impossible to get a good reading on cats in that environment! I had a vet friend come to my house to do it, that to me is the best way to do it. I also bought the BP monitor mentioned in this thread, but I don’t know if I trust that…
Thank you for this post. My Squeaky had high blood pressure. Just found out Cashew is diabetic when he had his dental.
Oh no, I’m sorry to hear about Cashew, Sue!
I have had 2 cats with hbp and offer these suggestions:
1)make sure the cuff fits the cat
2)if using a generic bp med, and it works, stay with the same generic (or only use the brand name)
Explanations:
1) our first cat had kidney disease and took kidney Rx, prednisone, and frequently got injections for anemia. We noticed her loss of sight; the vet sent us asap to a kitty vet ophthalmologist who diagnosed hbp related hemorrhages causing the retinas to detach. Our vet’s bp cuff was too big for our very tiny cat, so while she waited for a smaller cuff to arrive, she sent us to another vet (at her expense) who had a very tiny cuff. She started on Norvasc time release. She was so tiny that I had to open the capsule and use tweezers to select a certain number of each colored ball to give her the correct dose. I used only the brand name drug with her. Our cat retained 30% vision in one eye and about 50% on the other, and lived another 6 years.
2) Our next cat suddenly developed kidney disease, was diagnosed with hbp, and was also prescribed Norvasc, but the generic amlodipine was available so she started that, and improved right away. Several months later, she suddenly (literally overnight) was quite ill: swollen ankles, unsteady on her feet, puffy face, wouldn’t eat or drink). The vet did numerous tests and could find no cause. Then it occurred to me that I had just had the bp medicine refilled and when I checked, the pharmacist had filled it with a different generic. He called and got the first one delivered that day and the minute we switched her back to the original generic, all her sick symptoms went away! After that, I ordered the whole bottle of 90, which for her, was 6 months’ worth. The vet also did not bill us for the $300+ tests she had run, because she said she should of thought about a change in the generic drug. This cat lived another 5 years, taking only the bp med, Pepcid, and eating small wet meals (lower protein food, but not kidney diet, as she wouldn’t eat that)every 4-6 hours (my husband got up in the middle of the night and fed her), and no kidney rx’s.
Thank you for sharing your experience, Marie!
Norvasc (amlodipine) is the drug of choice for hypertension in cats. Older cats, especially those with kidney insufficiency, should have their blood pressure checked. I purchased an inexpensive monitor CONTEC08A-VET on Amazon. It takes some practice, but I can now monitor my elderly cat’s blood pressure.
I had no idea Amazon offered such an inexpensive monitor, Anne – thanks for sharing. For those of you interested, here’s the link: https://amzn.to/2JOub8g My only concern, given the slew of not very good reviews, is that you have no way of verifying accuracy. I’m curious whether the readings you get at home are close to what your vet gets in the office with a doppler?
I have never seen one of my vets take blood pressure. This is a bit concerning to me. But I wonder if it would be an accurate reading since they have all stressed really bad while there. I’m the same way too. I stress so bad for days before I go to a doctor and my blood pressure is always up when I get there.
Cassidy is 16 and diagnosed w hyperthyroidism 1 month ago. She can’t take methimazole and I noticed enlarged pupils. ( bloodwork showed stage 1 kidney disease) Took her to another vet to get blood pressure. It was 220 They took it 5 times, and I was w her. She also has head twitching w eyes blinking rapidly. She needs to be on hbp medication but my vet doesn’t want to prescribe it because of thyroid and kidney issues and she’s not sure what medication to prescribe. I have an internal medicine doc waiting after referral and paperwork are sent over. But that hasn’t happened yet. Plus then I wait for appt w specialist.. I’m terribly afraid for my cat. She is getting weaker by the day. What medication is safe for my Cassidy to take. I want to insist on having it for her. Letting doc off hook for any bad reaction. Seems to me the waiting while her eyes brain and heart are stressed is a bad reaction. Please help. This is the 3rd vet I’ve had in a month and she’s been in 4 times
It sounds like your cat needs to be seen by a veterinarian sooner rather than later – make sure the specialist knows that this is urgent. You may also want to consider taking her to the emergency service at a large veterinary referral center, it may speed up getting her seen by the internal medicine specialist if she’s admitted through the ER.
Our 19 year old cat Jade has been diagnosed with high blood pressure. The vet out her Amlodioine 1/2 .5mg which gave her back some of her lost vision. This worked for a few months but now her vision is really poor, especially at night. Will be contacting her Dr to see if increasing her dosage wiki help with her sight. She does have some kidney disease but earth well and doesn’t drink too much water. She knows her way around the house well and outside when we sit with her. I think we’re more upset about her vision issues that she is!
Does anyone have any experience taking their cats’ BP at home?
My 17 year old cat has been diagnosed with high blood pressure and is currently on Amlodipine, but I am wondering if he has “whitecoat syndrome.” I have never been in the room when they do the test. He consistently has two very different readings: greater than 200 when they do the test at the base of his tail compared to 138 or 140 when they do it on his “leg.” (not sure which leg) The vet even commented on the big discrepancy and said she would have to look in to that — but still kept him on the daily medication. We are to go back in 2 weeks. Can Amlodipine be harmful if he really doesn’t have high blood pressure?
Would it be possible for your vet to make a housecall? Your cat might not be as stressed at home and the readings might be more consistent.
Norvasc (amlodipine)
my cat is 18+ and has super hypothrois for some years with a resulting tumor. he also has some heart issues. But he is or was a happy cat eating, drinking, using cat box, playful and very impish such as hide and seek. We go out every day and go for long exploring walks. 2 days ago we were outside and he suddenly went blind. I rushed him to the vet and another vet looked at him and took his bp and said it was over 200 and that was what caused the blindness which is irreversible. I asked what his last bp reading was and she told me he had never had it taken. After reading up on this on the internet looking at many reputable sites I found out that any cat over 7 should have regular bp checks, especially if they have hyperthyroid which he has had for 4 years. I am so mad about this. How could a vet not know this or worse yet not care enough to follow well known procedures. My cat is now hiding in the closet and I am heartbroken. He cannot enjow any of his favorite activities. I consider this as close to malpractice as you can get. I am not a vet. I should’t have to sook on the internet to see what should be done to treat my cat. That is why I go to the vet in the first place. I have called several other vets to ask them what they would do and all of them say they would be checking bp regularly. I am devestated and can’t stop crying.
I’m so sorry this happened to your kitty, Marcia.
They very same thing just happened to us! My cat is 15, hyperthyroid and he never mentioned high blood pressure or blindness! He wants to send me to a specialist now after the damage is done! I’m so mad I don’t know what to do. She was so happy and loving and now sits starring at the wall. We are heartbroken.
I’m so sorry, Yvette. It ripped my heart apart when this happened to Buckley. I would take your cat to the specialist as soon as possible. Sudden onset blindness can be reversed in some cats, but immediate treatment is critical. All my best to you and your cat.
It may be at least partially reversible if your vet prescribes amlodipine immediately!
I appreciate this article! My orange son had hyperthyroid, resulting in extremely high blood-pressure. I feel it might have caused some type of small stroke. His front paw was a bit numb for some weeks, causing him to stumble when it curled under as he walked. Over time that went away. But the damage to his vision remains. He had the i13i radiation treatment after the medication got his BP & thyroid lowered. But I still wish I had realized his condition sooner so his vision was better and also spared him prolonged illness.
I’m sorry this happened to your boy, Karen. We always wish we could have done more, don’t we.
I just noticed my 19 yr old cats pupils were huge even during the bright sunny days…a few days later she started bumping into furniture and walking around in circles…i took her to the vet this morning and her BP was 217/ 90….very high for a cat!!!!! My vet took it three times and it went down a little bt never under 200….HYPERTENSION!!! i never know cats get high blood pressure and unfortunately it will be rare if her eyesight comes back…he perscribed a BP medication that is also used for people but a much lower dose of course. One of her kidneys is shrunken so we are testing for kidney, thyroid and liver fuctions withh blood tests. I am hoping the medication helps her feel better and less lethargic…she sleeps all day ..she still eats and drinks well and useds the litter box. Central Maui animal Clinic is so great with animals….i trust them completely with all seven of my animals…the vet said i should check her BP at least twice a year, especially for her age and get xrays which can show other things tht blood tests do not….they are very thourough
I’m so sorry about your kitty, Helene, but it sounds like she’s in good hands at your vet clinic. All my best to both of you.
I’m cat sitting my brothers two cats near Seattle, one of which is older & was diagnosed with hyperthyroidism 6 months ago at his vet in Chicago. Sunday night she was fine but I woke up at 6 am Monday morning & noticed she hadn’t moved & her posture was troubling. She was very weak, unresponsive to movement & when I tried to see if she could stand she couldn’t. She has had zero appetite, as well. After explaining to the new vet what happened & how quickly the first thing she did was check her BP. We all sat quietly on the floor with warm towels (she is a very spirited cat around strangers to begin with) & waited about 15 minutes for her to calm down. They then took 7 different BP rates before coming to a HIGH BP conclusion. They were all well over 200 & averaged out to 210. Very high, even for a stressed cat. She proceeded to check the eyes for retinal damage (negative), found the heart to have a galloping rhythm, took a full CHEM & CBC panel. I started her on the BP medicine about two hours later & she is already feeling better tonight & looks a whole lot better. She is eating again & drinking, walking better & looks much more like herself. We believe she may have had a small stroke.
My big issue is that even with the thyroid disease diagnosed at the vet in Chicago, they never bothered to check her BP? This is something we all need to ask them to do while getting our bi-anual or at least annual check-ups. Please share this info on checking your cats blood pressure. After some reading on it, I am shocked that it is not done regularly.
Thanks for sharing your experience, Darla. Thank goodness you noticed the change in this cat so quickly – her family is very fortunate to have a cat sitter like you! I agree that not enough vets check blood pressure routinely – it should be part of an annual or bi-annual check up, especially for senior cats.
Urgh! That makes my blood pressure goes up too! I can only imagine her to be some old deaf woman! Glad your furbaby is fine, though. 🙂
We took in my hyperthyroid cat to check his blood pressure. They shaved the underside of his tail, tried to put alcohol on it (! – I stopped that), and then slapped some cold gel on the shaved area. Then the vet came in, speaking VERY LOUDLY in the small, echoing room, and used large, sweeping gestures as she spoke…
Needless to say, they decided that my cat had very high blood pressure.
I was so dissatisfied with the whole procedure, I complained and my regular vet (who didn’t have the equipment, which is why we went to the ER to do this in the first place), set us up to test again. This time, the gel was warmed before it came anywhere near the cat, the cat was given time to settle, we had brought his favorite treats and warm towels for him to sit on (instead of the metal table), the vet came in (different one who knew the story and was trying to do it right this time), spoke very quietly, introduced himself to the cat, talked to him a while, then gently went through the procedure.
Blood pressure was completely normal.
So, yeah. Sometimes “whitecoat syndrome” is really “whitecoat not thinking the whole thing through from the cat’s point of view syndrome”.
These kinds of stories make my blood pressure go up, Mikken! Some vets just don’t get cats. I’m so glad you had your kitty rechecked again under better circumstances, and that everything was normal.
This article is SOOO important! Have you done a research of tensiometers (the device that measures blood pressure) for small animals? Would you recommend some in particular?
I would recommend asking your vet whether there’s one they recommend for in home use, Gabriela.