High Blood Pressure (Also known as Hypertension)
High blood pressure (HBP) occurs when the blood pushes against the walls of the arteries at a higher pressure than it should, causing damage to the arteries over time. As high blood pressure often causes no symptoms, it is known as the "silent killer". Uncontrolled high blood pressure can lead to coronary heart disease, stroke, kidney failure, aneurysms, and other serious medical problems.
High blood pressure is extremely common:
- 1 out of every 3 adults in the U.S. has high blood pressure (32%)1
- Only half of this group (54%) has their blood pressure under control1
The only way to find out whether you have high blood pressure is to have it checked regularly.
Checking Your Blood Pressure
Clinical guidelines state that in order to get a diagnosis of high blood pressure, the measurements must be obtained from at least two careful readings on at least two different occasions. Your blood pressure can fluctuate throughout the day. To get an accurate blood pressure reading, you should be sitting down, not ingested any caffeine for the previous 30 minutes, have an empty bladder, and not talk while the reading is taken. The blood pressure monitor at you neighborhood drug store is probably not going to give you an accurate measurement, especially if you are rushing in to pick up a prescription. If you are concerned about your blood pressure, discuss with your doctor buying a digital monitor you can use at home, and take it to your next doctor appointment so it can be calibrated to match your doctor's reading.
Blood pressure measurements consist of two numbers: the pressure of the heart as it contracts to pumps your blood around the body, which is the systolic pressure, and the pressure of the heart as it expands and fills with blood, which is the diastolic pressure.
Updated 2017 Guidelines for High Blood Pressure
New guidelines to determine who should be classified as having high blood pressure were released in 20172. Based on significant research, the new guidelines pulled many more people into the official "high blood pressure" designation, due to the higher incidence of coronary artery disease seen among this group of people.
New High Blood Pressure Guidelines
|BP Category||Systolic (first number)||Diastolic (second number)|
|High Blood Pressure Stage 1||130-139||or||80-89|
|High Blood Pressure Stage 2||>140||or||>90|
The good news is that not everyone who now meets the definition of "elevated" blood pressure is going to be given a prescription for medication. For most people in the elevated category, lifestyle changes are recommended and then BP measured again in 3-6 months. There are many lifestyle changes that can improve blood pressure; these are covered in a dedicated section below.
People who are in the high blood pressure Stage 1 and Stage 2 categories should also think about their other risk factors for cardiovascular disease and discuss these with their doctor when they are evaluating whether to take BP medication. A common tool is the atherosclerotic cardiovascular disease (ASCVD) risk calculator (link to the online version here), which uses blood pressure measurements, gender, age, cholesterol levels, and other factors to estimate a person's risk of developing cardiovascular disease in the next 10 years. Developed cooperatively by the American Heart Association and the American College of Cardiology, it is a valuable tool to help doctors and patients understand their overall risk for developing cardiovascular disease. In addition to high blood pressure, risk factors include:
- Age 55+
- Ethnicity (African Americans and South Asians are at higher risk)6
- High cholesterol
- Obesity (Body Mass Index of 25 or higher)
- Family history of cardiovascular disease or stroke
- Smoking (past or present)
Positive Lifestyle Changes You Can Make
Before you and your doctor consider medication to control your high blood pressure, there are several steps you can take, in fact, healthy food, exercise, and calm are powerful medicines. Listed below are lifestyle changes that have shown to help people lower their high blood pressure or prevent it from getting worse4:
- If you are a smoker, make a plan to quit. Nicotine is very addictive, and most people need help to quit, so talk to your doctor about new tools that are available. Smoking is very hard on the blood vessels and the heart, and smokers are more likely to develop high blood pressure than non-smokers3. Discover resources to help you quit here.
- Learn about and adopt the DASH diet, which is high in grains, fruits, vegetables, poultry, beans, nuts, and low-fat dairy. More information on the DASH diet can be found here.
- Make a conscious effort to be more active. Take the stairs, park in the farthest spot from the grocery store door, and get out and walk more often. If you need to, make a plan to reduce your weight, especially if your BMI is 25 or higher. An online BMI calculator can be found here.
- Lower your salt intake, consuming no more than 2300mg per day, or no more than 1500mg per day if you have already been diagnosed with elevated or high blood pressure.
- Limit your alcohol drinking: no more than two drinks per day for men and one drink per day for women.
- Manage your stress level through exercise, meditation, yoga, and other tactics. Find more information on stress management here.
Treating High Blood Pressure with Medications
In addition to the lifestyle changes discussed above, your doctor may recommend that you take medication to control your high blood pressure. This is because uncontrolled high blood pressure, over the long term, can seriously damage the blood vessels and organs. The most commonly prescribed high blood pressure medications are5:
- Diuretics: help the body get rid of excess water and sodium
- Beta-blockers: reduce the heart rate and the amount of blood pumped from the heart
- ACE Inhibitors: helps to open the blood vessels by reducing the body's production of angiotensin, a hormone that causes the blood vessels to narrow
- Calcium channel blockers: relax the arterial wall muscles and reduce the forcefulness of the heart's contraction
- Alpha blockers: reduces the muscle tone of the artery walls
Many other medications are available to treat high blood pressure, and sometimes a combination of two or three drugs is most successful in controlling high blood pressure. Based on your current health, the potential side effects of the medication, and your overall risk, you and your doctor can determine the best options for you.
It is important to remember that complications from high blood pressure can be severe. Studies have shown that even a 20-point higher systolic blood pressure or a 10-point higher diastolic blood pressure has been associated with double the rate of death from a heart attack, stroke, or other cardiovascular complication4.
Get your blood pressure checked, and take your medication as prescribed. Your family will thank you.
1Centers for Disease Control, https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm
2Journal of the American College of Cardiology Nov 2017, 24429; DOI:10.1016/j.jacc.2017.11.005, http://www.onlinejacc.org/content/early/2017/11/04/j.jacc.2017.11.005
4Harvard Health Publishing, Harvard Medical School, https://www.health.harvard.edu/blog/new-high-blood-pressure-guidelines-2017111712756
6Harvard Health Publishing, Harvard Medical School, https://www.health.harvard.edu/heart-health/race-and-ethnicity-clues-to-your-heart-disease-risk