Nearly 20 percent of adult Americans are living with hypertension — commonly known as high blood pressure — and don't know it, according to the latest estimates from the American Heart Association.
Only about half of the 78 million Americans diagnosed with hypertension are controlling it. And yet, uncontrolled high blood pressure is a major risk factor for devastating health problems — including stroke, heart attack, heart failure and kidney disease.
Hypertension is dangerous "because it's so often ignored," says Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center for Women's Health at NYU Langone Medical Center.
To protect your health, it's important to have your blood pressure checked by a professional — at least once a year. A blood pressure check measures the force of blood pushing against the artery walls as the heart pumps blood.
This pressure normally rises and falls throughout the day, but when it stays high over time, it's called high blood pressure — a chronic medical condition that damages arteries and requires the heart to work harder than normal to circulate blood to the organs.
Fortunately, there are steps you can take to prevent and control it. Here are 11 key questions and answers with the latest information on hypertension.
1. What are the symptoms of hypertension?
There usually are none, which is why it's been dubbed the silent killer. But if your blood pressure climbs to extreme highs, you might experience a severe headache, chest pain, shortness of breath, vision changes or a nosebleed, says George Thomas, M.D., of the Cleveland Clinic.
2. Am I at risk for high blood pressure?
Men and women are equally at risk over their lifetimes, but it is more common in African American adults than in Caucasian or Hispanic American adults, according to the National Heart, Lung, and Blood Institute. It's usually impossible to pinpoint an exact cause of high blood pressure. But it has been linked to a number of factors: Your risk increases if you have a family history of hypertension. And unhealthy lifestyle habits also can increase your risk — including smoking, too much salt in your diet, too much alcohol, lack of exercise, excessive weight and chronic stress.
3. Why is blood pressure measured in two numbers? Are they equally important?
Blood pressure readings have an upper and lower number, such as 120/80. The higher "systolic" number measures artery pressure when the heart beats, pumping blood to the organs. The lower, or "diastolic," number measures the pressure of blood in the arteries between beats, when the heart relaxes. For people 50 and older, the top number is more significant, according to the American Heart Association. Systolic blood pressure rises steadily with age because of changes in blood vessels.
4. What are "good" blood pressure numbers?
Lower than 120/80 is considered a normal, healthy reading. Higher numbers — up to 139/89 — suggest prehypertension, when you need to start making lifestyle changes to head off full-blown hypertension. A reading of 140/90 signals hypertension, which could progress to 160/100 or higher.
5. Can I avoid or control high blood pressure with lifestyle changes?
Researchers all agree that you can help control blood pressure if you reduce your salt intake, eat plenty of fruits and vegetables, exercise and maintain a healthy weight.
Studies have shown that blood pressure numbers can drop by five points with a weight loss of just 5 to 10 percent.
Reducing salt intake also can lower your blood pressure, says Samuel J. Mann, M.D., of New York-Presbyterian Hospital/Weill Cornell Medical Center. But in a controversial May report, the Institute of Medicine suggested that cutting salt to 1,500 milligrams daily — the current recommendation for those with hypertension — may actually increase health problems. It concluded there's no reason to reduce sodium intake to less than 2,300 mg daily (about a teaspoon of salt), the general level the government recommends for most Americans. Talk to your doctor about your salt consumption.
6. Is there a diet for hypertension?
Many doctors recommend the DASH diet — Dietary Approaches to Stop Hypertension. Along with controlling salt, it provides a basic, healthy eating plan with fruits and veggies, whole grains, nuts, legumes, low-fat dairy products and fatty fish such as salmon.
"The combination of a DASH diet with increased fruits and vegetables, along with regular physical activity, can lower blood pressure by 10 to 12 points," says Steven L. Kopecky, M.D., of the Mayo Clinic's Division of Cardiovascular Diseases.
7. Does alcohol affect my blood pressure? What about caffeine?
"Having a drink often lowers blood pressure temporarily, so people should not deny themselves a drink because they have hypertension," says Mann of New York-Presbyterian. But, he adds, "excessive drinking can contribute to hypertension."
As for caffeine: "Research shows caffeine's effect on blood pressure varies from person to person. If you metabolize caffeine quickly, it has no effect on your blood pressure. But if you metabolize it slowly, it can raise blood pressure. If you want to know if it affects your blood pressure, check your pressure after consuming caffeine and you'll know."
8. Which exercises lower blood pressure?
A new study in the journal Hypertension reviewed more than 1,000 studies and found that aerobic exercise, strength training and even isometric hand-grip exercises can reduce systolic blood pressure by two to 10 points. Surprisingly, four weeks of isometric hand-grip exercises, such as squeezing a small ball or athletic gripper, produced some of the most impressive improvements — a 10 percent drop in systolic and diastolic blood pressure.
Aim for 30 minutes of aerobic exercise—any activity that increases the heart rate and breathing, including gardening, walking and swimming — every day. Try to add strength training three times a week for 20 minutes, says Robert D. Brook, M.D., of the University of Michigan, the study's lead author.
Brook also recommends 12 to 15 minutes of isometric exercises such as hand-grip exercises three to five times per week.
9. What's the best way to check my blood pressure on my own?
A manual blood pressure monitor, the least expensive, includes an inflatable arm cuff, a gauge for readings and a stethoscope. A digital cuff monitor inflates and deflates automatically and calculates blood pressure. You'll also find digital monitors for wrist or finger — but they generally aren't recommended.
A digital cuff is easier to manage than a manual cuff, and users will get more accurate readings, says Mann. Make sure the cuff is properly positioned on the arm. Relax, with your arm supported on a table, when you take readings.
For accuracy, take a couple of readings — wait five minutes between them — and average them. Digital arm cuffs cost from $25 to more than $100, depending on features.
10. If I have to take blood pressure drugs, do they have side effects?
Different categories of medications can produce different side effects, including fatigue, dizziness, insomnia, sexual dysfunction, dry mouth, more frequent urination and even a cough. Work with your doctor to find the right medication.
11. If I get my blood pressure under control, can I reverse the damage?
"We don't know about 'reversing' damage — it depends upon the extent of it — but you can at the very least prevent and reduce further progression" of the damage, says Thomas of the Cleveland Clinic.
Stephanie Stephens is a freelance writer in Orange County, Calif.