Let's Talk About Hypertension
High blood pressure is all about the numbers. When your readings rise, your heart can pay a price. We'll help you stay safe.by Matt McMillen Health Writer
Every time you go to the doctor’s office, your M.D. straps an inflatable sleeve around your upper arm to test your blood pressure. You’ve likely gone through this routine so many times you don’t give it a second thought. We’re here to tell you should. High blood pressure (HBP) puts your heart health at risk—and, astoundingly, nearly one in two American adults has it. Now that we have your attention, we’d also like to point out that HBP is often highly treatable. Keep reading and we’ll tell you how to help curb the threat it poses to your body’s most important muscle.
Our Pro Panel
We went to some of the nation's top experts in hypertension to bring you the most up-to-date information possible.
Guy Mintz, M.D.
Director of Cardiovascular Health & Lipidology
Sandra Atlas Bass Heart Hospital
Swathy Kolli, M.D.
Luke Laffin, M.D.
Primary hypertension can’t be cured, per se, but it can be managed with lifestyle changes and, if you need them, medications. Because the disease is chronic, management will be a lifelong effort. The upside? Your life will be longer! If you have HBP due to an underlying (secondary) cause, treating that problem first might be enough to help your BP return to normal.
If your doctor recommends lifestyle changes alone, it will likely take between three to six months to determine whether they will do the job. If he or she determines medications are in order, you’ll be monitored and likely know sooner than that if the drug (or drugs) of choice has successfully lowered your numbers.
It usually takes years before organ damage occurs, but don’t give yourself a pass just because you don’t think it poses an immediate threat. HBP usually occurs alongside other concerns, like obesity and diabetes, so addressing it early and as aggressively as needed will improve your overall health.
Yes! If you are in pain, feeling anxious or afraid, or just finished a workout or a cup of coffee, your blood pressure has likely risen, but only temporarily. It will return to normal. While severe spikes are medical emergencies, such as those caused by eclampsia, most often, high blood pressure generally raises concerns when it becomes chronic.
What Is High Blood Pressure, Anyway?
Let's first begin with how the heart functions. With each beat, the heart pumps oxygen-rich blood to the rest of your body in an ongoing, life-sustaining cycle. The force—or pressure—of that contraction is what keeps your blood flowing through your arteries and veins.
There are two types of pressure that get generated:
Systolic, which is the pressure when your heart beats
Diastolic, which is your blood pressure between beats
A healthy blood-pressure reading is written out like this: 120/80 mmHg (millimeters of mercury), with the systolic number on top and the diastolic number below. Spoken out loud, you’ll hear: “120 over 80.” It’s only when your numbers spike higher than 129 (systolic) and tick upward of 80 (diastolic), that you’re venturing into hypertension—a.k.a. high blood pressure (HBP)—territory. (More on how those numbers break down in just a bit.)
Your blood pressure goes up when you’re active. It goes down when you chill out. It’s highest in the morning when you wake up and lowest when you sleep. These types of fluctuations occur normally. However, when it’s continually above normal, you have a problem.
Why? Because HBP can do A LOT of damage. It strains and stiffens your blood vessels, which can make your heart work harder than it should—and that can lead to a range of heart disorders, some of them quite serious.
How Does Hypertension Put Me at Risk for Heart Disease?
If you have HBP, you may not feel any different than you ever did, or even suffer the consequences for years. But over time you’re at increasing risk for developing four major heart problems. They are:
The hard work that HBP requires of your heart can cause part of it to thicken, a condition called left ventricular hypertrophy. When that happens your heart can no longer function as efficiently as it once did, leaving it unable to pump an adequate amount of blood to the rest of your body. Hypertension over many years can also cause the left ventricle to dilate and fail (known as dilated cardiomyopathy), another form of heart failure.
CAD develops most often as a result of atherosclerosis, a process in which a fatty substance called plaque builds up on the walls of your arteries. This can lead them to thicken and stiffen, which then restricts blood flow. The causes of atherosclerosis are unknown, but HBP is a prime suspect, because over time hypertension damages the arteries, making them more prone to plaque buildup—which can lead to CAD. So, it’s a bit of a vicious circle. (Other risk factors like smoking and high cholesterol are big concerns, too.) Unchecked, CAD can lead to a heart attack.
HBP is the leading cause of stroke, mostly because of the damage it does to the blood vessels. It not only raises the risk that plaque will rupture, it also increases the odds that blood clots will form in the heart. Both circumstances can block blood flow to the brain causing an ischemic stroke. The strain from HBP also can weaken blood vessels and make them prone to bursting. If this happens in the brain, it’s called a hemorrhagic stroke.
HBP harms the arteries that supply your kidneys with blood, leaving them unable to filter your blood sufficiently. It also makes them less able to produce aldosterone, the very hormone that helps control blood pressure. According to the American Heart Association, HBP is the second-leading cause of kidney failure.
What Causes High Blood Pressure in the First Place?
If you have HBP, you’re hardly alone. According to the Centers for Disease Control and Prevention (CDC), nearly half of all adults in the U.S. have hypertension or take a medication (sometimes more than one) to manage it. Only one-quarter of them have it under control.
Your doctor most likely won’t be able to pinpoint the reason why you have HBP. That’s because as many as 95% of HBP cases have no known cause. If you fall into this vast category, you have what’s known as primary hypertension. Among the much, much smaller number of people who do have a known cause, their HBP is known as secondary high blood pressure because it’s caused by an underlying, or already present, health condition.
These underlying secondary causes include:
Diabetes, which damages arteries and can lead to atherosclerosis, which in turn ups risk for HBP
Chronic kidney disease and other illnesses that affect the kidneys, which causes the vessels around the kidneys to narrow or harden, forcing the heart to pump harder and raising BP
Primary aldosteronism, which is when your adrenal glands (located near your kidneys) produce too much of the hormone aldosterone, forcing your heart to work harder, leading to HBP
Obstructive sleep apnea, which is a disorder that causes repeated, brief episodes of interrupted breathing while you sleep, putting long-term strain on your heart to raise BP
Thyroid problems, which is when the thyroid gland produces too much or too little of the thyroid hormone, straining the heart and leading to HBP
Birth defects, such as coarctation of the aorta, where the main vessel leading away from the heart is dangerously narrowed, causing HBP—which may be the first indication of congenital heart disease being present
Preeclampsia, which causes sudden spikes in blood pressure in pregnant women, resulting in eclampsia, a severe complication that leads to seizures, and puts those who have it at higher risk of HBP throughout their lives
What Are the Risk Factors for Hypertension?
While the exact causes of HBP remain a mystery in most cases, risk factors are much easier to identify. Fortunately, most of them are within your power to control—which means your heart’s destiny may lie largely in your own hands. They include:
If you’re overweight or obese, your body requires your heart to pump more blood to supply it with oxygen and other essential nutrients. This extra work adds to the pressure on the walls of your blood vessels.
Lack of Exercise
Regularly breaking a sweat allows your heart to work more efficiently, requiring fewer beats per minute to pump an adequate amount of blood. However, if you’re a couch potato, your heart may have to beat faster to keep up with demand. That means your heart’s working harder and putting more pressure on your blood vessels.
With every drag you take, the chemicals you inhale move through your lungs and into your bloodstream, where they damage your blood vessels along the way. Over time, this tough-to-kick habit significantly ups your risk of heart disease. Research suggests that vaping also raises blood pressure in a similar way—a good reason to avoid e-cigarettes, too.
High Salt Diet
Excess sodium causes fluid retention. The extra fluid in your blood vessels means your heart has to work that much harder to move it around your body, which boosts blood pressure.
Low Potassium Diet
When you don’t get enough potassium—found in foods like spinach, bananas, yogurt, and beans—the level of sodium circulating in your bloodstream rises.
Overindulging in Alcohol
We know, a little wine with dinner is nice. But exceeding the recommended daily limit of alcohol can bump up your BP. Current guidelines advise no more than one drink per day for women and two for men. A drink is a 5-ounce glass of wine, a 12-ounce regular beer, or 1.5 ounces of liquor.
Too Much Stress
Your body releases blood pressure-boosting hormones during times of stress. Too much stress, or not managing it well, also makes it harder to keep other HBP risk factors in check, like eating a poor diet, drinking too much alcohol, smoking, and losing sleep.
What Risk Factors for Hypertension Are Beyond My Control?
It’s important to focus on all you can do to prevent or better manage HBP. But some risk factors can’t be quit or improved. They include:
Your likelihood of HBP goes up as you get older. Why? The arteries begin to stiffen starting around age 55 in both women and men. This results in rising systolic (the top number) blood pressure, while diastolic BP tends to go down (likely because as we age the arteries stiffen and don’t spring back as well between heartbeats).
HBP also may be passed down to you from your parents. In fact, at least a third—and potentially up to half—of all cases of HBP have a genetic component.
African Americans have a higher risk of HBP than whites, which may be due to higher rates of diabetes and obesity, or to a gene that makes African Americans more sensitive to salt, according to the American Heart Association.
What Are the Symptoms of High Blood Pressure?
This is an easy one: For most people, there are no symptoms. The only way to tell if it’s present is to get tested. Still, if you leave HBP untreated long enough, it can cause noticeable damage to your heart, eyes, and kidneys. When that happens, you may experience symptoms like:
Shortness of breath due to heart problems
Vision problems ranging from blurriness to blindness from eye damage
Swelling, usually in your legs or around your eyes, due to kidney damage
How long does that take? Often years, but the process gets accelerated if you have other health problems, such as diabetes and high cholesterol. Extremely high blood pressure may also cause:
How Do Doctors Diagnose High Blood Pressure?
Because symptoms are so uncommon, the only way to know you have HBP is to have your blood pressure tested at your doctor’s office. Your doctor will use a device called a sphygmomanometer, which features an inflatable cuff that wraps around your upper arm. The cuff is attached to a scale, and when it inflates, it measures your systolic BP. It measures your diastolic BP as the cuff slowly deflates. Your doctor will also likely press a stethoscope to listen for any abnormal sounds as your blood flows.
You officially have HBP—your doctor may call it hypertension—when your readings are above normal during at least two visits to the doctor. However, many doctors will ask you to measure your own blood pressure using either a home monitor or with a 24-hour monitoring device your doctor lends you. Doing this will help confirm that your blood pressure remains high during the normal course of your day.
Why is this important? Many people have what’s called white-coat hypertension, which means that your blood pressure spikes in your doctor’s office but returns to normal elsewhere. For example, your reading may be high when you have a physical and normal when you use the device at your pharmacist or grocery store (though keep in mind these out-of-office devices don’t always give accurate readings).
Then there’s the reverse phenomenon: masked hypertension, in which your numbers fall into the normal range at the doctor’s office but not when measured elsewhere, such as with an at-home BP monitor. About 10% of people with HBP have masked hypertension. An estimated 15% to 30% have white-coat hypertension.
Let’s look at the numbers. The American Heart Association provides the measurements that you should aim for, as well as the ranges that put you in the danger zone. All measurements are mm Hg.
Normal: Systolic (the top number) below 120 and diastolic (the lower number) below 80
Elevated (prehypertension): Systolic 120 to 129 and diastolic below 80
High blood pressure (hypertension) stage 1: Systolic 130 to 139 or diastolic 80 to 89
High blood pressure (hypertension) stage 2: Systolic 140 or higher or diastolic 90 or higher
Hypertensive crisis (call your doctor immediately): Systolic higher than 180 or higher and/or diastolic higher than 120
In addition to identifying HBP, your doctor also will examine you to see if your HBP has already taken a toll on your health. That means checking your eyes for signs of retinopathy (damage to the blood vessels in your retina which can lead to blindness) as well as testing your kidney and heart function.
What Is the Best Treatment for High Blood Pressure?
Treatment frequently begins with lifestyle adjustments alone if your BP puts you in the elevated or stage 1 category, with an otherwise very low risk of developing heart disease over the following 10 years. Just like the risk factors above put you in the crosshairs of HBP, reducing those risk factors can help bring your BP back down.
Here’s where to start:
Focus on foods that are good for you and avoid those that are not. Sounds obvious, right? But it’s helpful to have a plan. One that’s proven to benefit HBP is the DASH diet, or Dietary Approaches to Stop Hypertension. This is a low-sodium diet that features lots of fruits, veggies, whole grains, and other good for you foods while lowering the amount of saturated fats, cholesterol, and sodium you consume.
Get a minimum of 150 minutes of moderate physical activity each week. That breaks down to about 30 minutes a day. Pick a workout you like because you’ll be more likely to stick with it. Better still, pick a few types of exercise. Variety keeps things interesting. Your exercise can be as simple as lacing up your sneakers and taking a walk, and it may be just as effective as taking a blood pressure medication, according to a 2019 British Journal of Sports Medicine review of scientific studies on the subject. Bottom line: Just get moving.
The above two will help you with this one. For every two pounds you drop, your blood pressure will go down by about one point. That’s significant. If you need help losing weight, which we know is not easy, try apps like Weight Watchers or Noom.
It’s so tough to do because nicotine is addictive. And, we know, many of you have tried to snuff out a smoking habit—more than once. Don’t give up! There are many smoking cessation methods out there, so if nicotine gum didn’t work for you, maybe hypnosis will. Or the patch. The important thing is to keep fighting for your heart—and your life. If you slip up try a fresh approach. You can do this. Your heart will thank you. For help, visit the American Heart Association to stop smoking forever.
None of us can completely avoid stress in our 24-7, go-go world. But we can learn to better manage it. Try deep breathing exercises, daily meditation, yoga classes, or even talk therapy to benefit your blood pressure levels. Just remember: Taking time for self-care is as important as taking care of your kids, your job, and everything else! No guilt here, ok?
Get Quality Sleep
Aim to get seven to nine hours each night. And if your partner tells you that you snore a lot, or you find yourself waking up breathless, ask your doctor about doing a sleep study. You might have sleep apnea, which can up your blood pressure and harm your heart.
Many of us unwind after a long work week with a drink or two—which, according to most research, is just fine. So enjoy your glass of wine or beer! It’s when you veer into heavy drinking, or too often exceed daily allowances, that your BP can spike.
What Are the Medications for Hypertension?
If you are in stage 2, or in stage 1 with an elevated risk of heart disease, you’ll need to make the above lifestyle modifications and probably get started on at least one blood pressure-lowering medication.
If your blood pressure is very high, you will need what’s called combination therapy, or medications from two different classes of drugs. Your doctor has many options to choose from. The choice will depend on the severity of your HBP as well as underlying health conditions you may have, like diabetes and heart disease. In all likelihood, your doctor will try you on more than one medication or dosage before determining what works best for you.
Short for angiotensin-converting enzyme inhibitors, this class of drug prevents your body from producing the blood vessel-narrowing and blood pressure-boosting hormone angiotensin II. These meds are often prescribed to people with diabetes because it also has kidney benefits.
Angiotensin II Receptor Blockers
ARBs for short, they also prevent angiotensin II from narrowing your blood vessels, easing the strain on your heart.
These drugs slow your heart rate so that it does not have to work as hard. This lowers your blood pressure.
Calcium Channel Blockers
These help your blood vessels to relax, allowing blood to flow more easily. They also lower BP by slowing your heart rate, give your heart a chance to rest.
Also known as water pills, these drugs help your kidneys flush sodium and excess fluids out of your body via your urine. Less fluid means less pressure on your blood vessels.
Treatments for Stage 2 HBP may involve combinations of the above classes, often in a single pill, such as a diuretic combined with a beta blocker or an ARB.
Up to one in six people with HBP have a treatment-resistant form of the disease, in which your blood pressure remains stubbornly high, even with lifestyle changes and medications. You may require several different drugs to get it under control. But truly resistant HBP is not common. It may be due to an underlying health condition that can be better managed, thus bringing your BP down. It also may be caused by a medication you’re taking for another health problem. Another possible explanation? You’re not taking your medication as directed, or you’ve had difficulty meeting your lifestyle goals, like weight loss and exercise. Your doctor can help you with that.
If your BP is considered a hypertensive crisis, that’s a medical emergency requiring admission to the intensive care unit of the hospital, where you will receive intravenous (I.V.) medications in an attempt to lower your BP quickly.
What’s Life Like With High Blood Pressure?
It can mean some big changes. Medication may not be enough to keep your BP under control if you don’t make and maintain appropriate lifestyle changes, like eating a more nutritious diet and getting plenty of exercise. This becomes even more critical as you get older, as BP frequently becomes more difficult to manage as you age. You also must maintain your daily medication regimen.
A critical component of your treatment likely will be a home blood-pressure monitor. Because HBP has no symptoms, the only way you’ll know your efforts are having the desired effect is to measure your BP on a regular basis. Your doctor will give you an appropriate schedule. Use these at-home readings as encouragement to stick to your self-care plan. If it won’t budge, discuss this with your doctor, who may recommend a different medication or dosage.
And, remember: It might seem like a lot of work to deal with a problem that doesn’t give you any obvious symptoms—for now, anyway. But trust us, lowering your blood pressure is the biggest gift you can give to you heart to keep it beating like a champ for years to come.
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High Blood Pressure (2.): Texas Heart Institute. (n.d.) “High Blood Pressure (Hypertension).” texasheart.org/heart-health/heart-information-center/topics/high-blood-pressure-hypertension
High Blood Pressure (3.): Centers for Disease Control and Prevention. (2020.) “High Blood Pressure.” cdc.gov/bloodpressure/index.htm
High Blood Pressure—Current Guidelines: American Heart Association. (2017.) “Highlights from the 2017 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults.” heart.org/-/media/data-import/downloadables/f/6/5/hypertension-guideline-highlights-flyer-ucm_497841.pdf
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High Blood Pressure and Weight Loss: American Heart Association. (2016.) “Managing Weight to Control High Blood Pressure.” heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/managing-weight-to-control-high-blood-pressure
High Blood Pressure and Stress: American Heart Association. (2016.) “Managing Stress to Control High Blood Pressure.” heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/managing-stress-to-control-high-blood-pressure
High Blood Pressure and Alcohol: The Mayo Clinic. (2019.) “Does drinking alcohol affect your blood pressure?” mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/blood-pressure/faq-20058254
High Blood Pressure Medications: Merck Manuals. (2019.) “Drug Treatment of High Blood Pressure.” merckmanuals.com/home/heart-and-blood-vessel-disorders/high-blood-pressure/drug-treatment-of-high-blood-pressure