A Patient’s Guide to High Blood Pressure

High blood pressure, or hypertension, often goes unnoticed until serious health issues arise. Unfortunately, many individuals are unaware of the impact of high blood pressure until they experience heart disease, kidney damage, or a stroke.

The recognized threshold for high blood pressure is when your readings consistently measure 130/80 mmHg or higher. According to the American Heart Association, approximately 122 million Americans currently have high blood pressure. The only definitive way to determine if you have high blood pressure is through regular blood pressure monitoring.

Now more than ever, patients are urged to monitor their own health and take proactive steps to mitigate their risks. The positive news is that if you’re diagnosed with hypertension, there are numerous strategies available to manage it, prevent complications, and bring your blood pressure back to a healthy range.


High blood pressure is usually diagnosed during a medical examination, where a healthcare professional will inquire about any symptoms and review your medical history.

During the examination, the healthcare provider will use a stethoscope to listen to your heart and measure your blood pressure using a cuff, called a sphygmomanometer, placed around your arm. The cuff is inflated to compress the brachial artery, briefly stopping blood flow before slowly releasing air.

A blood pressure reading consists of two numbers:

  • Systolic pressure (top number): This indicates the pressure your blood exerts against artery walls when the heart contracts.
  • Diastolic pressure (bottom number): This measures the pressure your blood exerts against artery walls when the heart is at rest between beats.

For individuals over 50, healthcare providers often focus more on the systolic blood pressure reading when assessing the risk of heart disease. Typically, systolic blood pressure increases gradually with age due to arterial stiffening and the accumulation of plaque over time. These factors can contribute to a higher risk of heart and vascular diseases.

Signs and Symptoms

High blood pressure earns its nickname, the “silent killer,” for a significant reason.

According to Suzanne Judd, a professor in the Department of Biostatistics at the University of Alabama at Birmingham, many individuals with chronic high blood pressure are unaware of their condition because they often don’t experience noticeable symptoms.

Unless facing a hypertensive crisis, a severe medical emergency where blood pressure rapidly rises to readings of 180/120, individuals are unlikely to exhibit warning signs of high blood pressure. However, untreated chronic high blood pressure can silently inflict damage over time.

Symptoms accompanying a hypertensive crisis or emergency may include:

  • Acute anxiety
  • Back pain
  • Chest pain
  • Difficulty speaking
  • Nosebleeds
  • Numbness
  • Severe headache
  • Shortness of breath
  • Weakness

Why You Must Control High Blood Pressure

A typical heart rate ranges from 60 to 100 beats per minute, with each heartbeat propelling blood through the intricate network of arteries, veins, and capillaries that constitute your circulatory system. This continuous circulation exerts a force against the walls of your arteries, known as blood pressure.

High blood pressure occurs when the small arteries, known as arterioles, which regulate blood flow throughout the body, constrict. This constriction places increased demands on the heart, compelling it to pump harder and elevating the pressure within the blood vessels.

Dr. Mitchell Elkind, Chief Clinical Science Officer of the American Heart Association and Professor of Neurology and Epidemiology at Columbia University in New York City, emphasizes the critical importance of managing high blood pressure: “The consequences of high blood pressure can be devastating, and lowering your blood pressure may save your life.”

High blood pressure is linked to various chronic health conditions that can significantly reduce lifespan. Dr. Elkind warns that “chronic high blood pressure may ultimately lead to heart failure or stroke, both of which can be fatal.”

Additionally, kidney disease is a significant complication, as high blood pressure can impair blood vessels in the kidneys, making it the second-leading cause of kidney failure in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Other potential complications of uncontrolled hypertension include vision loss, sexual dysfunction, and peripheral artery disease.

Blood Pressure and the Brain

The SPRINT-MIND study series, conducted by the National Institutes of Health, investigated the impact of intensive blood pressure management on brain health. Researchers aimed for a systolic pressure target of less than 120, comparing it to a less strict goal of less than 140. Their findings revealed that tighter blood pressure control was associated with a reduced risk of cognitive decline and dementia.

In a subsequent study presented at the American Stroke Conference in February 2023, researchers analyzed MRI scans of SPRINT-MIND participants. They observed positive changes in the brain’s perivascular spaces – crucial pathways involved in clearing toxins and waste products. Accumulation of these substances could potentially contribute to dementia development.

Dr. Elkind emphasizes the significance of maintaining healthy blood pressure for brain health: “Sustaining optimal blood pressure levels is crucial for preserving brain health. While we’ve long understood the link between high blood pressure and stroke risk, we now recognize its association with dementia and acknowledge that reducing blood pressure can mitigate cognitive decline. Dementia doesn’t have to be an inevitable outcome.”

Hypertension Risk Factors

Certain risk factors for high blood pressure are beyond individual control. Factors such as advancing age, a family history of hypertension, and being of African American descent elevate the likelihood of developing high blood pressure.

Chronic health conditions such as diabetes, kidney disease, and sleep apnea also contribute to an increased risk of hypertension. Pregnancy-related conditions like gestational hypertension and preeclampsia can lead to elevated blood pressure levels during pregnancy, with preeclampsia sometimes persisting in the weeks following childbirth.

Lifestyle factors also play a significant role. Being overweight or obese, leading a sedentary lifestyle, using tobacco, excessive sodium intake, and heavy alcohol consumption are all associated with a higher risk of developing high blood pressure.

Although typically associated with older adults, hypertension is increasingly prevalent in younger age groups. Dr. Elkind notes, “In recent years, hypertension has been observed in children and young adults.”

Recent statistics indicate that up to 5% of children and adolescents have high blood pressure, and nearly one-third of adults under the age of 45 in the United States have high blood pressure, according to the American Heart Association.

Women and High Blood Pressure

A recent statement from the American Heart Association highlights specific risk factors for women related to pregnancy, race, and ethnicity. Conditions such as gestational hypertension and preeclampsia, which can emerge during pregnancy, are associated with an elevated risk of developing high blood pressure even in the years following childbirth. These complications are more prevalent among Black women compared to women of other racial backgrounds.

Overall, non-Hispanic Black women in the United States exhibit the highest prevalence of high blood pressure.

Dr. Jennifer Mieres, Professor of Cardiology at the Zucker School of Medicine at Hofstra Northwell in Hempstead, New York, and Vice Chair of the AHA statement writing group, emphasizes the importance of healthcare teams recognizing these gender-specific factors when assessing women’s cardiovascular risk. She underscores the necessity of establishing partnerships with women to address their prevention and treatment needs.

Studies indicate that managing mild hypertension in women can positively impact pregnancy outcomes. A study published in the New England Journal of Medicine in May 2022 concluded that targeting a blood pressure of less than 140/90 mmHg in pregnant women with mild chronic hypertension led to better pregnancy outcomes compared to a strategy of treating only severe hypertension.

How You Can Control High Blood Pressure

Blood Pressure Medications

The Food and Drug Administration recognizes nine drug classes for treating high blood pressure, each with distinct effects on lowering blood pressure.

  1. Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors): These medications relax blood vessels by countering a hormone that narrows them. Commonly prescribed ACE inhibitors include enalapril (Vasotec) and lisinopril (Prinivil, Zestril).
  2. Beta Blockers: These drugs reduce the impact of stress hormones on the heart. Carvedilol and Labetalol are frequently used beta blockers.
  3. Diuretics: Also known as “water pills,” diuretics help eliminate excess water and sodium from the body, reducing pressure on blood vessel walls. Hydrochlorothiazide (Microzide) and chlorothiazide (Diuril) are examples of thiazide-type diuretics.
  4. Angiotensin II Receptor Blockers (ARBs): ARBs, like losartan (Cozaar) and valsartan (Diovan), also aid in relaxing blood vessels.
  5. Calcium Channel Blockers: These medications relax heart muscles and blood vessels by impeding calcium entry into cells. Amlodipine (Norvasc) and diltiazem (Cardizem, Tiazac) are common examples.
  6. Centrally Acting Agents: These drugs lower blood pressure by affecting the brain and nervous system. Clonidine (Catapres, Kapvay) and methyldopa are part of this class.
  7. Peripherally Acting Agents: These medications reduce blood pressure by preventing the release of stress hormones from the brain, adrenal glands, and certain tissues. Reserpine (Serpalan) is a peripherally acting antiadrenergic medicine.
  8. Vasodilators: Vasodilators like hydralazine and minoxidil directly target blood vessel walls to lower blood pressure.
  9. Renin Inhibitors: Aliskiren (Tekturna), a renin inhibitor, relaxes and dilates blood vessels to enhance blood flow.

Consult with a healthcare provider to determine the need and timing for antihypertensive treatment. Physicians may prescribe a combination of blood pressure medications to optimize effectiveness. It’s crucial to maintain open communication with the healthcare team regarding the benefits and side effects of individual medications.

“People should have a collaborative relationship with their physician and feel comfortable expressing if a medication doesn’t suit them,” stresses Judd, underscoring the importance of advocating for one’s health.

Certain medications, including over-the-counter NSAIDs and specific cough medicines, may elevate blood pressure. Patients with high blood pressure should seek guidance from their healthcare provider before using such medications.

Lifestyle Changes

Lifestyle modifications play a significant role in managing hypertension. Quitting smoking, moderating alcohol intake, maintaining a healthy weight, and engaging in regular physical activity can prevent or reduce high blood pressure. Dietary adjustments, such as consuming a diet rich in fruits, vegetables, and whole grains while limiting sodium, processed meats, and sugary snacks and beverages, are beneficial. Potassium-rich foods are also essential for blood pressure regulation.

According to government recommendations, adults should engage in at least 150 minutes of physical activity per week, with the type and intensity of exercise tailored to individual factors such as age and health status.

Although genetics contribute to blood pressure risk factors, approximately 70% of blood pressure control can be achieved through lifestyle changes, with medications accounting for the remaining 30%, according to Dr. Nicholas Ruthmann, a cardiologist at Cleveland Clinic in Ohio.