Is High Blood Pressure Genetic?

Can high blood pressure run in families?

Families share more than just genetics. They may have similar lifestyles, and some of these, like their diets, can also contribute to high blood pressure.

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“If you grow up in a family that has a very high-sodium diet; a family that lives in a food desert, where you don’t have access to healthy foods; that lives in a high-pollution area; that lives in a psychologically stressful situation, your blood pressure is going to be high,” says Leslie Cho, M.D., director of the Women’s Cardiovascular Center and section head of preventive cardiology and rehabilitation 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. More than half — 58 percent — of Black adults in the U.S. have hypertension, while less than half of white (43 percent), Asian (42 percent) and Hispanic (42 percent) adults do.

As with families, people of the same race or ethnicity may have similar diets, lifestyles and personal histories. These may explain race-based differences in hypertension risk more than genetics.  

Black people in the U.S. also face many social, economic and environmental challenges that could contribute to high blood pressure. They may be more likely to live in places where they can’t access healthy food or to live in neighborhoods or work hours that aren’t conducive to getting out and exercising. They may also have more hurdles to accessing basic health care, including routine blood pressure checks.

A 2020 study of 1,845 Black American adults in the journal Hypertension linked experiences of discrimination to increased risk for high blood pressure.

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.”

Genetics could play a role, though. For instance, research suggests that Black people may be more sensitive to salt, known as salt sensitivity of blood pressure (SSBP), than other people, meaning that a high-salt diet affects their blood pressure more than another person’s. This, Kullo says, could be genetic.

“One theory is that in Africa, the climate is such that you would sweat a lot, so the body had to develop mechanisms to preserve sodium,” he says. “But then when, because of the unfortunate slave trade, people were brought to these temperate, colder climates, [Black people] still had this tendency to retain sodium, and so that made them a bit more predisposed to high blood pressure.”

Are blood pressure risks different for men and women?

Almost 50 percent of adult men have high blood pressure, while about 40 percent of women do. Men tend to develop high blood pressure earlier than women, but women’s risks increase more sharply as they age. By age 60, the rate of hypertension for men and women is about the same.

There are differences, though. Women’s bodies may be more sensitive to high blood pressure overall, and what’s considered a safe and normal blood pressure may be lower for women than for men.

A 2021 study of 27,000 adults in the journal Circulation found that women face risk for complications from high blood pressure, such as heart attack, heart failure and stroke, when their systolic blood pressure (the number on top) is higher than 110. For men, the threshold is 120.

Hormonal changes may also play a significant role in women’s blood pressure. Research from the American Heart Association suggests that women of all ages are more sensitive to salt than men. Menopause seems to worsen SSBP, which means hormone replacement therapy may keep salt sensitivity and blood pressure under control.

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, which experts are now recognizing isn’t an isolated event, quadruples a woman’s risk of high blood pressure later in life. Women who had preeclampsia during pregnancy should get regular blood pressure checks throughout life.

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How can you lower your blood pressure?

You can’t change your genes, but there are things you can change that might have a much bigger impact on your risks for high blood pressure.

“If you have genetic risk, it doesn’t mean you are destined to have high blood pressure,” Kullo says. “You can reduce your risk through lifestyle, for example, by avoiding weight gain, sedentary behavior and excessive salt and alcohol.”

According to the American Heart Association, a few key lifestyle changes can go a long way to keeping your blood pressure in check:

• 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 American Heart Association 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 that adults get 150 minutes — or 30 minutes a day, five days a week — of moderate-intensity activity every week. But, Cho says, it’s important that you’re moving all day, not just during a 30-minute bout of exercise.

“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 number one 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 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 1 in 4 have it under control,” Cho says. “The goal of therapy is that you live longer and have a higher 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.