It's easy to ignore high blood pressure, or hypertension, until health complications strike. Unfortunately, many people don't realize the impact of high blood pressure until they develop heart disease, have kidney damage or suffer a stroke.
The official standard for high blood pressure recently changed, with the threshold lowered to 130/80 mmHg. More than 100 million Americans now have high blood pressure, according to the American Heart Association. As guidelines and treatment parameters shift, you may not know whether you have high blood pressure or how to safeguard your health.
More than ever, patients are encouraged to track their own progress and take proactive measures to reduce their risks. The good news is that if you're among the many people diagnosed with hypertension, there's plenty you can do to manage it, prevent complications and bring your blood pressure down to a normal range.
The public health challenge is that most people can't feel chronic high blood pressure, says Suzanne Judd, a professor in the department of biostatistics with the University of Alabama at Birmingham.
High blood pressure is called the "silent killer" for good reason. Unless you're experiencing the medical emergency known as a hypertensive crisis, you're unlikely to have symptoms that serve as high blood pressure warning signs. For most people, untreated chronic high blood pressure will slowly but steadily do its damage over time.
Hypertensive crisis is when blood pressure rapidly spikes to readings of 180/120, according to AHA guidelines. Severe headache, shortness of breath, nosebleeds and acute anxiety may be accompanying symptoms. Hypertensive emergency encompasses the elevated blood pressure reading along with symptoms such as chest or back pain, weakness, numbness or difficulty speaking.
A normal heart rate runs at about 60 to 100 beats per minute. Every heartbeat pumps blood through the arteries, veins and capillaries – your network of blood vessels. The ceaseless blood flow continuously pushes against the arterial walls. This never-ending force is your blood pressure.
High blood pressure is caused when tiny arteries called arterioles – which regulate the body's blood flow – become tighter. This constriction forces your heart to pump harder, causing pressure to build within the blood vessels.
Hypertension consequences can be devastating and lowering your blood pressure can be lifesaving. The risk reduction is particularly strong in terms of improving cardiovascular health and reducing brain complications like stroke, says Dr. Wanpen Vongpatanasin, director of the Hypertension Fellowship Program at University of Texas Southwestern Medical Center in Dallas. By contrast, uncontrolled high blood pressure can shorten your life. "Ultimately when you have heart failure and stroke, you increase mortality," she says.
Kidney disease is another major complication. High blood pressure, which can damage blood vessels in the kidneys, is the second-leading cause of kidney failure in the U.S., according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Vision loss, sexual dysfunction and peripheral artery disease may also result from ongoing, uncontrolled hypertension.
The SPRINT study series looked at the effects of intensive blood pressure control – with a systolic pressure (the upper number) of less than 120 as the target – on specific medical conditions. Heart attack, unstable angina, stroke and heart failure are reduced when high-risk patients have tightly controlled blood pressure, compared to a less-stringent goal of a systolic blood pressure of less than 140, researchers found.
Tight blood pressure control may help preserve brain function, emerging evidence suggests. "In more recent trials, we begin to see a pattern of potential effects on cognitive function," Vongpatanasin says.
Results of the SPRINT MIND study were reported Jan. 18, 2019, in the Journal of the American Medical Association. Tight blood pressure control reduced the risk of probable dementia by 17% compared to standard blood pressure control. This difference was not statistically significant. However, tight blood pressure control was tied to a 19% lower rate of mild cognitive impairment – a significant finding.
Some risk factors for high blood pressure are beyond your control. Older age, a family history of hypertension and being African American increase your likelihood of developing hypertension.
Chronic medical conditions such as diabetes, kidney disease and sleep apnea put you at higher hypertension risk. Gestational hypertension and preeclampsia are high blood pressure conditions that can arise during pregnancy.
Being overweight or obese increases your risk, as does having a sedentary lifestyle. Tobacco use, consuming too much salt (or sodium) and heavy drinking also increase your risk.
Although older adults are more likely to have high blood pressure, it's increasingly showing up earlier in life. "Quite recently, we started seeing it in very young people under the age of 20, as well," says Judd, who is the director of the Lister Hill Center for Health Policy at the UAB School of Public Health. "That's probably due to the way more and more Americans are becoming obese. It's definitely a concern."
Blood Pressure Medications
Nine drug classes are used to treat high blood pressure, according to the Food and Drug Administration. Each medication class has different blood pressure lowering effects:
Angiotensin converting enzyme inhibitors. ACE inhibitors help relax the blood vessels by counteracting a hormone that otherwise narrows them. Enalapril (Vasotec) and lisinopril (Prinivil and Zestril) are frequently prescribed ACE inhibitors.
Beta blockers. These reduce the effect of stress hormones on the heart. Metoprolol (Lopressor and Toprol-XL) and nadolol (Corgard) are commonly used beta blockers.
Diuretics. Also known as "water pills," diuretics work on the kidneys to help flush excess water and sodium from the body and thereby reduce fluid pressure on blood vessel walls. Thiazide-type diuretics to treat high blood pressure include hydrochlorothiazide (Microzide) and chlorothiazide (Diuril).
Angiotensin II receptor blockers. These also help relax the blood vessels. Losartan (Cozaar) and valsartan (Diovan) are two types of ARBs.
Calcium channel blockers. As the name implies, these drugs relax the heart muscle and blood vessels by blocking calcium from entering cells. Amlodipine (Norvasc) and diltiazem (Cardizem and Tiazac) are examples.
Centrally acting agents. These medications reduce blood pressure through their effects on the brain and nervous system. Clonidine (Catapres and Kapvay) and methyldopa belong to this class.
Peripherally acting agents. By preventing the brain, adrenal glands and certain bodily tissues from releasing stress hormones, peripherally acting antiadrenergic medicines like reserpine (Serpalan) help reduce blood pressure.
Vasodilators. Vasodilators such as hydralazine and minoxidil work by directly targeting blood vessel walls.
Renin inhibitors. The renin inhibitor drug aliskiren (Tekturna) also helps blood vessels relax and dilate to improve blood flow.
Whether and when to start antihypertensive treatment is a discussion to have with your health care provider. Individual hypertension medications have unique benefits and side effects. Doctors may prescribe two or more blood pressure lowering drugs in combination to maximize the effect.
Finding the right drug regimen is also a two-way process. "People should have a good, collaborative relationship with their physician to be comfortable saying, 'This medication does not make me feel well,'" says Judd, who emphasizes the importance of being in control of and an advocate for your own health.
Lifestyle
Hypertension is a health condition for which lifestyle changes really make a difference. Cutting back on risk factors such as smoking and heavy drinking, maintaining a healthy weight and staying physically active can help prevent or reduce high blood pressure.
Adults should do at least 150 minutes of physical activity a week, according to government recommendations. The type and intensity of exercise or activity may vary depending on your age, general health or chronic medical conditions.
In 2017, the American College of Cardiology and American Heart Association jointly released new guidelines for preventing, detecting, evaluating and managing high blood pressure. Self-monitoring blood pressure at home was a guideline focus.
Regular at-home monitoring reveals blood pressure fluctuations and trends that periodic clinic appointments or checkups simply can't capture. Staying on top of your blood pressure number is "critical," Judd says. Sharing ongoing blood pressure trends with your doctor will better inform treatment goals.
A recent study led by Vongpatanasin, published December 2018 in the journal Hypertension, supported the value of home monitoring.
For more accurate, consistent results, Judd offers these self-monitoring suggestions:
Buy a blood pressure monitor that's easy to use and read, Judd advises. Monitors with big numbers and a single push-button can simplify blood pressure tracking. The American Heart Association offers an online blood pressure tracking tool.
In general, maintaining a healthy weight helps keep blood pressure under control. Eating plans like DASH, which stands for dietary approaches to stop hypertension, offer specific food choices. A vegetarian or Mediterranean diet might also be helpful, Vongpatanasin says.
Salt sensitivity affects about 30% of people, she points out. Salt sensitivity, which has a genetic connection, makes it harder for the body to get rid of excess sodium. Table salt only accounts for a small proportion of the sodium most people consume. Anyone with high blood pressure, and particularly those with salt sensitivity, should carefully read food labels and check sodium levels.
Researchers continue to examine alternative approaches to reducing blood pressure. In some studies, meditation and relaxation techniques have shown modest benefits in reducing blood pressure, according to the National Center for Complementary and Integrative Health.