High blood pressure, or hypertension, has been called a ‘silent killer.’ It’s also known as an ‘invisible’ illness. What that all means is high blood pressure doesn’t cause obvious symptoms that patients — or doctors — can readily detect by observation alone.
The issue is that if high blood pressure isn’t caught and controlled, it can eventually cause serious health damage including heart disease and stroke. Early in the COVID-19 pandemic, people with high blood pressure fared worse in terms of severe illness, hospitalization and death.
On the flip side, certain conditions like sleep apnea can cause high blood pressure and its consequences. Either way, regular blood pressure checks — at health care visits and at home — can spot high blood pressure, prevent or pinpoint medical problems and pave the way for a treatment plan.
Hypertension is known as an invisible condition for good reason. “Most of the time, high blood pressure has no symptoms,” says Dr. Anjali Mahoney, the chief medical officer for Venice Family Clinic, based in Los Angeles.
“There’s a hypothetical risk of having a headache and maybe visual changes as a first presentation when people have high blood pressure, and chest pain or having a stroke — but usually people don’t have such extreme symptoms,” Mahoney says. “It’s usually just, they come to the doctor for something else and they’re found to have high blood pressure.”
What Is High Blood Pressure?
First, what is blood pressure? Your arteries are the blood vessels that transport blood from your heart to your body. As part of normal circulation, every heartbeat pushes blood through the arteries — which causes pressure in the arteries. This blood pressure is essential for blood flow. However, when blood pressure is too high, it puts stress on your heart and can lead to damage of the arteries and bodily organs.
A blood pressure reading includes two components:
— Systolic. Your systolic blood pressure is the top number in a blood pressure reading. So, it’s the “120” in 120/80. The systolic represents the highest blood pressure in your arteries, while the heart is pushing blood out to the body.
— Diastolic. Your diastolic blood pressure is the bottom number in a blood pressure reading. So, it’s the “80” in 120/80. The diastolic represents the lowest blood pressure in your arteries, while your heart is relaxed.
What Constitutes High Blood Pressure?
High blood pressure isn’t diagnosed by a single reading, but rather as a pattern. Blood pressure is classified in the following stages for adults:
— Normal blood pressure. Less than 120/80.
— Elevated blood pressure. Systolic is 120-129 and diastolic is less than 80.
— Stage 1 high blood pressure. Systolic is 130-139, or diastolic is 80-89. (Typically, both numbers are high, but in isolated diastolic hypertension, an uncommon form, only the diastolic blood pressure is high.)
— Stage 2 high blood pressure. Systolic is 140 or higher, or diastolic is 90 or higher.
Blood pressure classifications are established by the American College of Cardiology and the American Heart Association. In 2017, previous blood pressure stages were lowered to the current numbers in recognition that even Stage 1 blood pressure can damage health over time and so needs to be treated.
Signs of High Blood Pressure Problems
A sign is a disease manifestation that doctors or other clinicians can perceive. A symptom is a disease manifestation that patients notice themselves. It’s rare to detect high blood pressure by symptoms alone. Unfortunately, notable high blood pressure symptoms tend to occur from long-term damage to various parts of the body.
“It affects many organs in your body if you have persistently high blood pressure,” Mahoney says. “It can affect your eyes, it can affect your kidneys, it can affect your blood vessels.” Signs of persistently high, untreated blood pressure may include:
— People may have decreased vision. This can be due to damage to the retina, a part of the eye, from a condition called hypertensive retinopathy.
— Some people have mini-strokes. One-sided numbness or weakness, difficulty with speaking or understanding others, difficulty with walking or balance are symptoms.
— People can start losing feeling in their fingertips or toes if peripheral vascular disease develops.
— Kidney damage may not cause symptoms, but can progress to the point where people need dialysis.
“It just depends on how long someone’s had hypertension,” Mahoney says. “People can have high blood pressure for a long time and end up with end-organ damage before they even know they have hypertension. Sometimes end-organ damage is the first presentation. Someone will end up with a stroke and you realize that they had hypertension.” That’s why it’s important for patients to establish a relationship with a primary care provider to enable diagnosis and preventive treatment.
What Causes High Blood Pressure?
Causes of high blood pressure in an individual patient aren’t always clear. High blood pressure can run in families and is more likely with certain risk factors:
— Older age.
— Being Black.
— Family history.
— Being overweight or having obesity.
— Being sedentary or fairly inactive.
— Alcohol overuse.
— Salt overuse.
Certain medical conditions can cause or contribute to high blood pressure:
— Renal hypertension. In this kidney disease, the arteries that transport blood to the kidneys are narrowed, which reduces circulation to the organ. In response, the kidneys make a hormone that causes the blood pressure to rise.
— Hormonal problems. Hyperthyroidism, or too much thyroid hormone, may cause high blood pressure. Cushing’s syndrome, or overactive adrenal glands, may cause high blood pressure too.
— Sleep apnea. When untreated, sleep apnea can lead to high blood pressure. Treating sleep apnea with continuous positive airway pressure (CPAP) can help reverse it.
— Diabetes. People who have diabetes are more likely to develop high blood pressure, although the reason for this is uncertain.
High Blood Pressure Urgency
“One of the main messages is that for all practical purposes there are no signs of high blood pressure,” says Dr. Willie Lawrence Jr., medical director of the Center for Better Health and Wellness in Benton Harbor, Michigan, medical director of health equity for Spectrum Health Lakeland in St. Joseph, Michigan, and a volunteer expert for the American Heart Association. “When you start having signs of hypertension that means you already have end-organ damage. So this is not a disease that can wait for signs and symptoms.”
It’s imperative that blood pressure be measured on a regular basis, Lawrence says: “The prevalence of hypertension is so great.” Nearly half of adults in the U.S. population (47%) have hypertension, according to the Centers for Disease Control and Prevention. “You want to know what your blood pressure is in time for it not to have done damage to your body,” he emphasizes.
Hypertension prevalence increases as a population ages, Lawrence notes. “It’s going to be higher for Blacks than for whites at any given age,” he adds. “So, as you age, it’s not enough to check your blood pressure when you’re 40. You really should have it checked yearly.”
Lack of monitoring is a major concern. “If you go to a physician’s office or other health provider’s office, you will have your blood pressure monitored,” Lawrence says. “So, part of the problem is that people who are at the greatest risk don’t go to the doctor’s office. They don’t check their blood pressure frequently enough.”
Mahoney echoes concern over missed hypertension. “It’s more common in men than women,” she says. “Men are more likely not to want to go to the doctor. It’s important that anyone, but specifically men, go and see a primary care clinician at least once a year.”
Lawrence points to the National Hypertension Control Initiative, launched in late 2020 to address gaps in managing high blood pressure, specifically to improve COVID-19-related health outcomes among racial and ethnic minority populations. With federal funding, the collaboration between the American Heart Association and partners is raising awareness of high blood pressure and promoting its prevention in a multipronged community approach.
High Blood Pressure Treatment
Effective treatment for high blood pressure is available and affordable. Medication and lifestyle changes can help most people manage their blood pressure.
High Blood Pressure Medication
Getting doctors to prescribe accordingly and patients to adhere to treatment recommendations is a public health challenge. In January 2022, the medical journal Hypertension published an American Heart Association scientific statement on medication adherence and blood pressure control.
A variety of factors contribute to the gap between blood pressure goals and adherence to recommendations, says Dr. Wanpen Vongpatanasin, director of the Hypertension Section at University of Texas Southwestern Medical Center in Dallas and an AHA statement co-author. For example, hypertension may be better controlled for some patients by using more than one medication. However, patients might be concerned about side effects or not see the need to take additional drugs, Vongpatanasin says. Physicians might hesitate to add yet another drug to a patient’s medication regimen.
That’s why a collaborative relationship between doctors and patients is so important for chronic disease management, Vongpatanasin says, to continually watch for side effects, adjust medications as needed and accommodate patients’ needs or lifestyle barriers to treatment.
Lack of symptoms is one reason patients might not perceive the need to take blood pressure medication. “It’s easier to get patients to take cold syrup when they’re sick than it is to take a pill every day when they don’t feel anything,” Lawrence says. “One of the challenges of managing hypertension is getting people to understand that once you have the symptoms or signs (they) represent the fact that hypertension has done its damage and your efforts are no longer just preventive.”
The good news is that timely treatment works. “Blood pressure can actually be improved pretty quickly,” Vongpatanasin says. “Even with once-a-day regimens, you can see maximum effects within a few weeks. Within a week, you can see things starting to improve.”
Lifestyle to Lower Blood Pressure
You can take non-medication steps to help keep blood pressure under control. Natural ways to lower blood pressure include:
— Lose weight. Taking off a moderate 10-20 pounds or so can reduce your blood pressure numbers.
— Exercise. Adding physical activity and aerobic exercise to usual care may reduce blood pressure even in people with hard-to-treat hypertension, according to a systematic review published in April 2022.
— Curb alcohol. Drinking less — no more than one drink daily for women or two for men — can help.
— Follow a healthy diet. The DASH diet — which stands for dietary approaches to stop hypertension — is a proven way to control blood pressure. In general, eating vegetables and other plant foods helps.
— Limit salt. Some people are particularly salt-sensitive — their blood pressure rises as they consume more salt. You can cut salt while cooking, grocery shopping and eating out.
— Quit smoking. Hypertension can be a consequence of long-term smoking. Talk to your doctor about smoking cessation.
— Increase potassium. If you have low potassium, consuming potassium-rich foods such as bananas and tomatoes can help reduce high blood pressure. However, this is not recommended for people with abnormal kidney function.
While lifestyle measures can help reduce your blood pressure and reduce your overall well-being, you might still need to take blood pressure-lowering medication.
Taking Blood Pressure Properly
Blood pressure readings — both at doctors’ offices and at home — must be taken correctly for the most reliable results. Blood pressure-taking tips include:
— Be seated in a chair.
— Sit quietly for five minutes or so to relax.
— For the reading, sit upright with your back supported and your feet on the floor.
— Your arm should be supported at heart level, by resting it on a countertop or table.
— Place the cuff over bare skin, not a sleeve.
You need a reliable blood pressure monitor to ensure accurate readings. The US Blood Pressure Validated Device Listing features devices that have been independently evaluated and met criteria for clinical accuracy. Developed by the American Medical Association, you can access the listing at validatebp.org and filter it for home devices.
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Update 07/25/22: This story was previously published at an earlier date and has been updated with new information.