En español | Hypertension, or high blood pressure, is one of the most common health conditions plaguing American adults. And as a key risk factor for heart disease — the world's leading killer — it's also one of the most dangerous.
In the U.S. alone, more than 500,000 deaths each year are linked to high blood pressure, according to the Centers for Disease Control and Prevention (CDC). Globally, the death toll tops 7 million.
But there is good news: High blood pressure is both preventable and treatable once diagnosed. Here are five reasons why you shouldn't delay getting your blood pressure checked.
What is high blood pressure?
|Category||Systolic Blood Pressure||Diastolic Blood Pressure|
|Normal||<120 mm Hg||<80 mm Hg|
|Elevated||120-129 mm Hg||<80 mm Hg|
|Stage 1 Hypertension||130-139 mm Hg||80-89 mm Hg|
|Stage 2 Hypertension||≥140 mm Hg||≥90 mm Hg|
1. The ‘silent killer’ rarely comes with symptoms
Unlike other health conditions that pop up with warning signs, high blood pressure (defined as 130/80 mm Hg or higher) rarely comes with symptoms, which is how it earned the name “the silent killer.” In fact, about 1 in 3 people who have hypertension don't know it, according to the CDC.
The only way to know for sure if you have high blood pressure is to check your numbers. If you are 40 or older, you should be doing this at least once a year, federal guidelines state. A health care provider can measure it in the office; your local pharmacy may also have a blood pressure machine.
Home monitoring is an option, too, and one that many experts recommend — especially if nerves interfere with your readings during routine health appointments. (You can purchase a monitor for under $50.) Just be sure to keep a log of your blood pressure measurements so you can review them with your doctor at your next appointment. And pay attention to how you take your blood pressure: Experts recommend emptying your bladder and avoiding food or drink 30 minutes ahead of time. Also be sure to keep both feet flat on the ground, place the cuff on bare skin and rest your arm with the cuff on a table at chest height.
2. Your risk for high blood pressure increases with age
Several factors can drive up a person's risk for developing hypertension. People with diabetes and obesity, for example, are more likely to develop high blood pressure. Smoking, physical inactivity, drinking too much alcohol and eating too much salt can also increase risk. Family history plays a role, too — so does age.
"That's because the blood vessels kind of stiffen in a way where they're less flexible” as you age, says Nieca Goldberg, M.D., clinical associate professor in the Department of Medicine at NYU Grossman School of Medicine and medical director at the Joan H. Tisch Center for Women's Health. And that loss of elasticity drives up the pressure inside the vessels.
Even if you've had healthy blood pressure levels in the past, it's important to stay on top of your numbers as you get older. Once you hit middle age, your lifetime risk for developing high blood pressure is 90 percent, research shows.
3. The ‘new normal’ may be lower than you think
The definition of high blood pressure has changed in recent years. Before 2017, anything below 140/90 mm Hg was considered OK. Now, a blood pressure at or above 130/80 mm Hg is deemed high, according to updated guidelines from the American College of Cardiology and the American Heart Association.
"This still comes as a surprise to many patients, even though that recommendation has been in place now for nearly four years,” says Erin Michos, M.D., a cardiologist and an associate professor in the Division of Cardiology at Johns Hopkins School of Medicine. “Many patients are still not familiar with the new targets.”
Results from a large federal study called SPRINT are a major reason for the change in guidelines. Researchers found that adults age 50 and older who brought their systolic blood pressure below 120 mm Hg significantly lowered their risk for heart attack, heart failure or stroke by 25 percent, compared with adults with a systolic blood pressure of 140 mm Hg. They also slashed their risk of death by 27 percent.
"That's huge,” said Cora Lewis, M.D., professor and chair of the Department of Epidemiology in the University of Alabama at Birmingham School of Public Health, who worked on the study. “That's people who did not die.”
In fact, the benefits of intensive blood pressure control were so obvious that the study was stopped early. However, several years of follow-up data, published last month in the New England Journal of Medicine, confirm the initial findings.
"The most important message is that blood pressure control is important, that blood pressure control literally saves lives,” says Mahboob Rahman, M.D., professor of medicine at Case Western Reserve University and the division chief of nephrology and hypertension at University Hospitals Cleveland Medical Center. “If you work with your doctor to control your blood pressure well, you will be at lower risk of developing heart disease; you live longer, literally.”
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4. Risks are low when it comes to lowering blood pressure
Clinicians have a tendency to be more cautious when it comes to treating hypertension in older adults, who are more likely to have multiple chronic conditions and are at increased risk for falls, Michos says. (Dizziness and lightheadedness can be symptoms of blood pressure that's too low.) But recent research shows that fear is a bit unfounded.
A 2016 sub-analysis of SPRINT data revealed that intensive blood pressure control in adults 75 and older did not result in more injurious falls. It did, however, result in significantly lower rates of cardiovascular events and death.
Another finding that challenges a common concern when it comes to older adults: Aggressively treating blood pressure didn't raise participants’ risk of experiencing orthostatic hypotension — that feeling of dizziness when you go from sitting to standing because of a drop in blood pressure.
"That actually gets better when you treat blood pressure better,” Michos says. “And that might sound paradoxical, but it may be that once you just get better control of blood pressure in general, then some of the things that lead to orthostatic hypotension” also get treated, she explains.
As far as other risks go, the final report from the SPRINT trial looked at additional safety measures of intensive blood pressure control and found that conditions like electrolyte abnormalities and acute kidney injury were more common in the intensive-treatment group. However, rates of serious adverse events overall did not differ significantly between the groups.
The key to going lower with blood pressure management, Goldberg says, is to pay attention to your symptoms. “We need to reframe this: If you have a blood pressure of 110/70 and you're not dizzy or lightheaded or fainting, then that blood pressure is fine. It's not just about the number, it's about how you feel,” she says.
Your doctor can also help go over any risks related to lowering your blood pressure.
5. Lower blood pressure is a boon for the brain
Better brain health is another potential benefit of managing high blood pressure. Researchers on the SPRINT MIND study found that participants who had their systolic blood pressure controlled to 120 mm Hg had a lower incidence of mild cognitive impairment — a precursor for dementia — compared with participants in the standard (140 mm Hg) group.
"With all that in mind — the lower rate of major adverse vascular events, the reduction in stroke, the reduction of mortality, the trend for better brain health — all of this is in favor that we should be doing a better job of treating older adults with high blood pressure,” Michos says.
Make a plan with your provider — and stick with it
Making some lifestyle adjustments can have an impact on your blood pressure. For example, a small reduction in sodium can cause your blood pressure to drop by about 5 or 6 points. And a 2-pound weight loss can shave about 1 point from your readings, according to the Mayo Clinic.
Medication can also help, and patients shouldn't feel any shame in turning to this “tool for prevention” if it's recommended by your health care provider, Goldberg says.
The key is to “pick a goal” for your target blood pressure and then work with your doctor to get there — even if it requires a gradual approach, says the University of Alabama's Lewis. “If you do well at 140 and you want to go down to 130, OK. Do it. But let's just stop living with blood pressure that's not well controlled. Let's just not do that anymore.”
What the top and bottom numbers measure
Systolic pressure: The top number is a measurement of the force exerted by your heart each time it beats on the walls of your arteries.
Diastolic pressure: The bottom number is a measurement of the force exerted by your heart between beats on the walls of your arteries.
mm Hg: The letters that follow the systolic and diastolic numbers — mm Hg — stand for millimeters of mercury, which is how pressure is measured in medicine.
Source: Mayo Clinic
Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.