Is High Blood Pressure Genetic?

Polygenic risk scores: What they can (and can’t) tell you

Using the gene variants discovered in recent studies, researchers can calculate a polygenic risk score (PRS) — a measure of inherited blood pressure risk based on the number of risk-raising variants a person carries.

PRS testing for hypertension is primarily a research tool. Major medical groups have not yet recommended it for use in a doctor’s office or clinical setting, citing limited guidance on how results should change treatment decisions. But the National Human Genome Research Institute says polygenetic risk scores may one day become a regular part of how we manage our health care. 

What’s more, medical experts emphasize that lifestyle and medication decisions should still be guided by blood pressure readings at your doctor’s office or through home monitoring, not solely by genetic scores or family history.

Can high blood pressure run in families?

Families share more than just genetics. They may have similar diets, activity levels, stress exposure and access to health care.

“If you grow up in a family with a very-high-sodium diet, limited access to healthy food, high pollution or chronic psychological stress, your blood pressure is more likely to be high,” says Dr. Leslie Cho, director of the Women’s Cardiovascular Center at the Cleveland Clinic.

Does race play a role in high blood pressure?

Hypertension rates vary across racial groups. Black Americans, for example, are more likely to have high blood pressure than U.S. adults of any other race.

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Research suggests that some people — including a higher proportion of Black adults — may have salt-sensitive blood pressure, meaning sodium intake has a stronger effect on blood pressure.

Black adults in the U.S. also face many social, economic and environmental challenges that can contribute to high blood pressure. They may be more likely to live in places that lack access healthy food, or live in neighborhoods or work hours that aren’t conducive to getting out and exercising. Many also face hurdles accessing basic health care, including routine blood pressure checks. Recent expert reviews note that race itself is a social construct — and that differences in blood pressure risk reflect a combination of factors, rather than genetics alone.

A cause of higher rates of hypertension in Black Americans, Kullo says, “may be, to a large degree, the environment, like stress, structural racism, air pollution and other environmental factors, but there may be some genetic component.”

Are blood pressure risks different for men and women?

Men tend to develop hypertension earlier, but women’s risk rises sharply with age. Statistically, more men than women have hypertension up to age 74, but after age 75, the reverse is true. 

Women’s blood pressure risk increases after menopause, and hormonal changes play a role. Research suggests women are more sensitive to salt than men are, and menopause may worsen salt sensitivity.

How a woman’s body responds to the stresses of pregnancy — like gestational hypertension, or preeclampsia — might also indicate how her body will respond to changes later in life.

“Some women who’ve never had high blood pressure develop it while they’re pregnant,” Cho says. “Pregnancy is like a stress test for the heart.”

Preeclampsia — high blood pressure during pregnancy — more than doubles a woman’s long-term risk of hypertension and cardiovascular disease. Women who had preeclampsia during pregnancy should get regular blood pressure checks throughout life. 

How can you lower your blood pressure?

You can’t change your genes, but you can change many factors that affect blood pressure risk.

Current guidelines emphasize that lifestyle changes can offset much — and sometimes most — inherited hypertension risk, even in people with high genetic susceptibility.

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The American Heart Association (AHA) advises:

• Don’t smoke or vape. Smoking may make high blood pressure worse and harder to treat. Almost immediately after quitting, a smoker’s blood pressure begins to return to a healthier level.
• Eat a heart-healthy, low-sodium diet. The DASH diet (dietary approaches to stop hypertension) is proven to lower blood pressure, but simply following national guidelines for a healthy diet is beneficial too. To maintain a healthy blood pressure, the AHA recommends no more than 2,300 milligrams of sodium per day. But if you already have high blood pressure, you should limit it to 1,500 mg per day.
• Get regular exercise. The Centers for Disease Control and Prevention recommends adults get 150 minutes of moderate-intensity activity every week — or 30 minutes a day, five days a week. But, Cho says, it’s important that you’re moving about all day, not just during a 30-minute bout of activity. “Forget just the time that you exercise at the gym,” she says. “Throughout the day, you should be moving.”
• Maintain a healthy weight. “In America, the No. 1 risk factor [for high blood pressure] is weight — weight and diet, which are all related,” Cho says. If you’ve got some pounds to shed, regular physical activity and a healthy diet will help you get there.
• Cut back on alcohol. Routinely having more than three drinks in one sitting can lead to high blood pressure. Women should limit alcoholic drinks to one a day; men should stop at two.
• Get sleep disorders under control. Sleep apnea is a known cause of high blood pressure. If you snore, have been told you gasp for air when you sleep, or wake up with dry mouth or a headache, ask your doctor if you could have sleep apnea.
• Take your medicine. If you already have high blood pressure and your doctor prescribes medicine to keep it down, take it.

“Nearly half of adults have hypertension, but only about 1 in 4 has it under control,” Cho says. “The goal of treatment is longer life and better quality of life.”

Editor’s note: This story, originally published June 3, 2024, has been updated to include new information and new reporting from Sarah Gleim and Kimberly Hayes.