Hypertension University

CAT HEALTH UNIVERSITY

Feline Hypertension: The Complete Guide for Cat Parents

Medically reviewed by Kevin Toman, DVM — 40+ years of clinical veterinary experience, founder of the Pet Longevity Institute. Last reviewed August 2026.

There are FOUR (4) Diseases that threaten almost every older cat, and we have a summary of them for you here.  HCM gets two pages -- one on the disease, one on what I have learned in its treatment:

OK, NOW FEATURING HYPERTENSION--

High blood pressure — systemic hypertension — is one of the most under-diagnosed conditions in senior cats, largely because it causes no obvious symptoms until it has already damaged an organ. The most devastating example is sudden blindness from a detached retina, which can happen with no warning in a cat whose blood pressure was never checked. The good news: hypertension is simple to screen for, straightforward to treat, and highly effective at protecting the eyes, kidneys, heart, and brain once it's caught.

What Is Feline Hypertension?

Systemic hypertension means sustained elevation of blood pressure throughout the body. In cats it is almost always secondary — a consequence of another underlying disease, most commonly chronic kidney disease or hyperthyroidism, rather than a standalone ("primary" or "idiopathic") condition, though primary hypertension does occur in a minority of cases. The danger of hypertension isn't the blood pressure number itself — it's the damage sustained pressure does to delicate blood vessels in the eyes, kidneys, heart, and brain, collectively referred to as target organ damage (TOD).

Symptoms and Target Organ Damage

Hypertension itself is usually silent. What owners actually notice is the downstream damage:

  • Sudden blindness or dilated pupils — from retinal detachment or hemorrhage; this can happen with no warning and is a common way hypertension is first discovered
  • Disorientation, wobbliness, seizures, or altered behavior — from hypertension-related effects on the brain
  • A new heart murmur, gallop rhythm, or worsening of pre-existing heart disease — hypertension increases the heart's workload over time
  • Worsening kidney values — hypertension both results from and accelerates chronic kidney disease, so the two often progress together
  • Occasional nosebleeds (epistaxis) in severe cases

Because target organ damage can be sudden and irreversible (permanent blindness from retinal detachment is common), routine blood pressure screening — not waiting for symptoms — is the entire point of managing this condition well.

Causes and Risk Factors

  • Chronic kidney disease — the most common underlying cause; see our CKD University page
  • Hyperthyroidism — the second most common cause; see our Hyperthyroidism University page
  • Age — screening is recommended for all cats over 9, and especially those with either condition above
  • Primary (idiopathic) hypertension — a smaller subset of cases with no identified underlying disease

How Is Hypertension Diagnosed?

  • Indirect blood pressure measurement — via Doppler ultrasonic or oscillometric devices, performed in a calm environment with the cat acclimated to the room; measurements are typically taken multiple times and averaged, since a single high reading can reflect stress ("situational" or "white-coat" hypertension) rather than true sustained disease
  • Fundic (retinal) exam — looking for hemorrhage, retinal detachment, or vessel changes that indicate existing target organ damage
  • Bloodwork and urinalysis — to identify or rule out CKD and hyperthyroidism as the underlying cause
  • Repeat measurement — because of the white-coat effect, a diagnosis of sustained hypertension generally requires consistent elevated readings across more than one visit, unless target organ damage is already present, in which case treatment shouldn't wait

Staging: ACVIM Blood Pressure Categories

The 2018 ACVIM Consensus Statement on systemic hypertension classifies cats (and dogs) into four categories based on systolic blood pressure (SBP), each with an associated risk of future target organ damage:

Category Systolic BP Risk of target organ damage
Normotensive < 140 mmHg Minimal
Prehypertensive 140–159 mmHg Mild
Hypertensive 160–179 mmHg Moderate
Severely hypertensive ≥ 180 mmHg Severe

Treatment is generally recommended once SBP is persistently ≥160 mmHg, or immediately at any level if target organ damage is already present. The treatment goal is to bring SBP below 140–150 mmHg.

Treatment Options and Drug Doses

Treating the underlying cause (CKD or hyperthyroidism management) is always part of the plan, but blood pressure itself is usually also treated directly and promptly, since target organ damage can occur while the underlying disease is still being brought under control.

Amlodipine (first-line)

A calcium channel blocker and the standard first-line treatment for feline hypertension. Typical starting dose: 0.125–0.25 mg/kg once daily (commonly rounded to 0.625 mg per cat for smaller cats or 1.25 mg per cat for larger cats), increasing up to 0.5 mg/kg once daily if blood pressure isn't adequately controlled at recheck. Cats with severe hypertension (SBP over 200 mmHg) sometimes require higher doses from the start.

Telmisartan (alternative or add-on)

An angiotensin receptor blocker (ARB), often chosen when hypertension is accompanied by significant proteinuria, or added if amlodipine alone isn't sufficient. Labeled dose (as an oral solution): 1.5 mg/kg twice daily for the first 14 days, then 2 mg/kg once daily. In cats with concurrent CKD, some clinicians start at a lower 1 mg/kg once daily and titrate based on response.

These are general reference doses from veterinary literature, not a prescription. The right starting dose, formulation, and titration schedule depend on the individual cat's blood pressure severity, kidney function, and response to treatment, and should be set by the prescribing veterinarian.

Dietary Therapy

Sodium restriction is a well-established piece of the management plan for cats with hypertension, particularly when heart disease coexists. For evidence-based, detailed guidance on heart- and blood-pressure-healthy nutrition — including specific low-sodium food lists — we recommend Tufts Cummings School of Veterinary Medicine's HeartSmart nutrition guidance, developed by their board-certified veterinary cardiology and nutrition service.

  • Avoid high-sodium treats and table foods (deli meats, cheese, canned fish packed in salt, etc.)
  • If your cat also has CKD, a renal therapeutic diet already addresses sodium restriction — a separate hypertension-specific diet usually isn't needed on top of it
  • Adequate hydration supports overall cardiovascular and kidney health alongside sodium management
  • Any dietary change should be made gradually and discussed with your veterinarian, particularly in a cat with concurrent kidney disease

Monitoring Schedule

  • After starting or changing antihypertensive medication: recheck blood pressure within 7–14 days
  • Once stable: recheck blood pressure at least every 3 months, alongside monitoring of the underlying cause (kidney values, thyroid levels)
  • Fundic exam: repeated periodically to confirm resolution or stability of any target organ damage found at diagnosis
  • Urine protein:creatinine ratio (UPC): checked periodically, since proteinuria is an important predictor of outcome in hypertensive cats and is frequently under-monitored in general practice

Prognosis

With consistent treatment and monitoring, feline hypertension is very manageable and most cats maintain a good quality of life. The prognosis is most closely tied to two things: how quickly treatment was started relative to any target organ damage (vision loss from retinal detachment, for instance, does not always reverse even once blood pressure is controlled), and the course of the underlying disease driving the hypertension — CKD or hyperthyroidism. Cats whose hypertension is caught before any organ damage occurs generally do very well long-term.

Frequently Asked Questions

What blood pressure is considered high in cats?

A systolic blood pressure of 160 mmHg or higher is generally classified as hypertensive under ACVIM guidelines, with treatment typically recommended at this level or immediately if target organ damage is already present.

What causes high blood pressure in cats?

Most feline hypertension is secondary to another disease, most commonly chronic kidney disease or hyperthyroidism. A smaller number of cases have no identified underlying cause.

Can high blood pressure cause blindness in cats?

Yes. Sudden blindness from retinal detachment or hemorrhage is one of the most common ways feline hypertension is first discovered, and vision loss does not always reverse even with treatment, which is why routine screening matters.

What is the first-line medication for feline hypertension?

Amlodipine, a calcium channel blocker, is the standard first-line treatment, typically started at 0.125-0.25 mg/kg once daily and adjusted based on recheck blood pressure.

How often should senior cats have their blood pressure checked?

Annual blood pressure screening is recommended starting around age 9, and more frequently in cats with chronic kidney disease or hyperthyroidism, since both conditions commonly cause secondary hypertension.

Does diet affect blood pressure in cats?

Sodium restriction is a well-established supportive measure, particularly when heart disease is also present, though medication is typically the primary treatment for confirmed hypertension.

Is hypertension in cats related to kidney disease?

Yes, closely. Hypertension can both result from and accelerate chronic kidney disease, so the two are checked and monitored together. See our CKD University page.

Can a single high blood pressure reading mean my cat has hypertension?

Not necessarily. Stress from the vet visit itself ("white-coat" or situational hypertension) can elevate a single reading. Diagnosis of sustained hypertension generally relies on multiple consistent readings, unless target organ damage is already present.

What is telmisartan used for in cats?

Telmisartan is an angiotensin receptor blocker used as an alternative or add-on to amlodipine, often favored when significant proteinuria is present alongside hypertension.

Can feline hypertension be cured?

If an underlying cause like hyperthyroidism is cured (for example with radioactive iodine), hypertension may resolve. When the cause is chronic kidney disease, hypertension is typically a lifelong condition managed with ongoing medication rather than cured.

Additional Resources & Sources

From Dr. Kevin and the Cat Longevity network

Primary and reference sources

This page is for educational purposes and does not replace an individualized diagnosis, staging, or treatment plan from a veterinarian who has examined your cat. Drug doses referenced above are general starting points from veterinary literature, not a prescription — actual dosing must be determined by your prescribing veterinarian.