High blood pressure, also known as hypertension, is often called the “silent killer.” Why the sinister nickname? It’s silent because it almost never produces any noticeable symptoms. And it’s a killer because hypertension is a leading cause of heart disease – and heart disease is the top cause of death among American women and men. High blood pressure also greatly increases the risk of stroke and numerous other health conditions.
High blood pressure is a serious health threat. Consider these statistics:
- 120 million adults (48.1%) have high blood pressure
- About one in four adults with high blood pressure do not know they have it
- Fewer than one in four adults with high blood pressure have it under control
- Roughly 34 million Americans who should be taking prescription medication for hypertension are not
This American Heart Month, Privia Medical Group North Texas is doing a deep dive on hypertension, a disease that affects far too many but one we can fight back against effectively through medication and lifestyle changes.
What is Hypertension?
Blood pressure is the force of blood pushing against the walls of the arteries. If the force of blood is too strong, damage to the arteries may result over time. High blood pressure also causes the heart to work harder to pump blood, eventually leading to heart damage.
Our blood pressure is measured in millimeters of mercury (mmHG). A blood pressure reading measures the force of blood against the arteries in two ways:
- Systolic (upper number): when the heart beats
- Diastolic (lower number): when the heart is resting, in between beats
Blood pressure readings can be classified as:
| Blood Pressure Status | Reading |
| Normal | Less than 120/80 |
| Elevated | Systolic between 120-129 and diastolic less than 80 |
| Stage 1 hypertension | Systolic between 130-139 or diastolic between 80-89 |
| Stage 2 hypertension | Systolic at least 140 or diastolic at least 90; |
| Hypertensive crisis | Systolic over 180 and/or diastolic over 120 |
The root cause of high blood pressure is usually unknown. It is a condition that often develops gradually with age.
All adults should have their blood pressure checked by a medical professional periodically:
- Men and women, age 18-39: every three to five years.
- Men and women, age 40 and older: every year.
If blood pressure is elevated, your physician may ask you to have it checked more frequently.
Causes of Hypertension
Though there is typically not a single, identifiable cause of high blood pressure, many different factors are known to contribute to the condition. As with many other heart-related conditions, some are beyond our control while some can be influenced by lifestyle choices and adjustments.
Factors beyond our control, also known as primary hypertension, include:
- Age: people over 55 are more likely to have high blood pressure
- Genetics: a family history of hypertension may increase the likelihood of getting it
Secondary hypertension occurs when there is an identifiable cause. These are factors that can be shaped by lifestyle and health choices:
- Smoking or vaping
- Eating too many salty foods; excessive sodium intake is bad for blood pressure
- Low potassium levels
- Drinking excessive amounts of alcohol
- Stress
- Sedentary lifestyle: physical activity helps to lower blood pressure
Lastly, body weight can have a big impact on blood pressure. If someone is overweight or obese, this can increase the likelihood of hypertension. While weight can be influenced by food choices and exercise levels, it can also be outside a person’s control.
Family history and one’s metabolism play a role in how efficiently we burn calories. But even if being overweight is not something that the patient can control through diet changes and exercise, there are medical treatments that can help. Weight-loss surgery may be an option for some people. For many patients, medications such as GLP-1s can help.
While GLP-1s are not approved as a blood pressure treatment by the Food and Drug Administration at this time (they are approved as a diabetes and weight loss treatment), there is growing evidence to suggest that the weight loss caused by GLP-1s has a direct and positive impact on blood pressure in many patients.
Effects of High Blood Pressure
Elevated blood pressure, over time, can cause serious damage to the body. Hypertension is linked to:
- Atrial fibrillation (AFib): Occurs when the heart beats erratically, diminishing its ability to pump blood
- Coronary artery disease (CAD): Narrowing of the arteries in the heart
- Heart attack
- Heart failure: The heart’s ability to pump is damaged
- Peripheral artery disease (PAD): narrowed or blocked arteries in the arms or legs
- Chronic Kidney Disease (CKD)
- Stroke
- Aneurysm
- Vision problems
- Cognitive issues, including dementia
- Pregnancy complications
Treatment for Hypertension
“When we diagnose a patient with hypertension, we generally attack it with a two-pronged strategy,” explains Dr. Sam Nassar, a Fort Worth cardiologist. “First, we’ll often prescribe medication to bring the blood pressure under control. Then, we’ll work with the patient on lifestyle improvements that will also help lower blood pressure.”
Medications
Treatment for high blood pressure depends on the patient’s medical history, level of hypertension and any identified causes of the condition. Common medications used to treat the condition include:
- Diuretics: These help the patient shed excess fluid. When the body carries too much fluid, the heart is forced to work harder to pump blood.
- Beta-blockers: These help block adrenaline, slowing the heart rate and relaxing the arteries.
- Calcium channel blockers: Blocking calcium can also reduce the heart’s workload.
- ACE inhibitors: These help to widen the blood vessels, allowing the heart to pump blood more easily.
- ARBs: These work in a similar way to ACE inhibitors.
Lifestyle Changes
Virtually all of the steps we can take to improve our overall health will also have a positive impact on blood pressure:
- Eating more fruits, vegetables, fiber, whole grains, lean meat and fish
- Avoiding foods that are high in sodium
- Maintaining a healthy weight
- Getting plenty of physical activity each day
- Getting enough sleep, usually 7-8 hours a night
- Managing stress
- Drinking alcohol only in moderation or not at all
- Not smoking or vaping
“For any of these lifestyle adjustments, your doctor recognizes that these can be challenging,” says Dr. Nassar. “We are here to help you accomplish any and all of these things with guidance, advice and support.”
Monitoring Blood Pressure
For anyone diagnosed with hypertension, it is important they regularly monitor their blood pressure at home. While taking blood pressure readings at home does not take the place of regular visits to your physician, it will help you recognize if treatments are working and your numbers are moving in the right direction.
Choosing a Monitor
The American Heart Association provides detailed guidance for choosing the correct blood pressure monitor. You can read all their recommendations here, but these are some of the most important points:
- Choose an automatic monitor with a cuff that fits over your arm. An automatic monitor is one that runs on electricity or batteries, versus the old-fashioned kind that you pump with your hand.
- Avoid wrist or finger blood pressure monitors.
- Make sure your monitor has been validated. You can ask your doctor or pharmacist for advice or visit www.validatebp.org for a list of options.
- Ensure you select a monitor with the correct cuff size. Measure your bicep and choose a corresponding size.
Taking a Reading
Many different factors can affect your blood pressure throughout the day. You want to remove as many variables as possible to get an accurate reading:
- Go to the bathroom before measuring; a full bladder can elevate your blood pressure
- Don’t drink caffeine or exercise for at least 30 minutes before taking a reading
- Do not place the cuff over clothing; it should be on your bare arm (either arm is fine)
- Sit in a level chair and rest your arm on a table or desk
- Make sure your legs are not crossed and both feet are flat on the floor
- Your upper arm should be positioned at the same level as your heart
- Measure your blood pressure at the same time each day
Know Your Numbers
Just because blood pressure is silent doesn’t mean we have to remain in the dark! See your doctor periodically to ensure your blood pressure is checked by a medical professional.
If you’re one of the nearly half of all Americans who have elevated blood pressure, the good news is that there are numerous treatment options available. Both medication and lifestyle adjustments can help lower your numbers.
Knowing what your blood pressure is – and getting it to a healthy level – is one of the most important things you can do to protect your heart and your overall health.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
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