5 things you should know about high blood pressure

Why worry about high blood pressure if you haven’t been diagnosed with it?

“Over time, 90 percent of people in this country develop hypertension,” says Stephen Havas, professor of preventive medicine at the Northwestern University Feinberg School of Medicine. That’s because blood pressure typically creeps up as you age.

1. What is high blood pressure?

Blood pressure is the force that your blood exerts on the walls of the arteries it flows through, just like water flowing through a garden hose pushes against the hose’s walls.

Your blood pressure consists of two numbers. Systolic—the higher number—is the pressure on blood vessel walls during a heartbeat. Diastolic—the lower number—is the pressure between beats.

When people have high blood pressure—also called hypertension—it’s often because blood vessels are too rigid to expand when the heart pumps.

2. Your risk rises before your blood pressure is “high.”

Doctors diagnose patients with high blood pressure when their systolic pressure reaches 140 or their diastolic pressure hits 90. But rising pressure is a threat to your blood vessels before it crosses either of those lines.

“People don’t realize that blood pressure higher than 120 over 80 is associated with increased risk,” says Havas. “Between ‘normal’ and ‘hypertension’ you have a huge number of heart disease and stroke deaths attributable to excess blood pressure.”

The National Heart, Lung, and Blood Institute (NHLBI) calls those in-between blood pressures “prehypertension.” Roughly one out of three American adults have it. Another one out of three have full blown hypertension.

“As blood pressure increases, the damage increases,” says Norm Campbell, professor of medicine, community health sciences, and physiology and pharmacology at the University of Calgary in Canada.

3. Hypertension harms more than just the blood vessels.

High blood pressure doesn’t just raise heart attack and stroke risk.

“As blood pressure rises, all of the blood vessels in the body are damaged,” explains Campbell. “And that causes strokes, heart attacks, heart failure, kidney failure, dementia, impotence, and difficulty with walking” due to peripheral artery disease.

4. Don’t rely on drugs to lower your pressure.

So what if you get high blood pressure? Can’t you just take a drug to lower it?

“You don’t want to wait until your blood pressure crosses that magic threshold of 140 over 90,” says Havas, “because by that point you’ve already done a fair amount of damage to your heart, vascular system, kidneys, and brain.”

What’s more, only about half of the 75 million Americans with hypertension have their blood pressure under control—that is, below 140 over 90. The other half includes people who aren’t being treated and those who don’t even know they have hypertension.

“Hypertension is a chronic condition that doesn’t make the patient feel anything,” explains Norman Kaplan, professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas. “If people with, say, rheumatoid arthritis don’t take their medication, they hurt. So they’ll take that medication. But people with hypertension don’t experience anything obvious.” So many stop.

5. You can help keep your blood pressure low.

Want to lower your blood pressure or keep it from climbing in the first place? This game plan can have a big impact.

What works chart

JNZPHTPRTFind this article about high blood pressure interesting and useful? Order a copy of our new bookSafe & Easy Steps to Lower Your Blood Pressure. Nine out of 10 Americans will eventually have high blood pressure, and, with it, an increased risk of stroke, heart attack, diabetes, dementia, and more. But hypertension isn’t inevitable. Eating the right diet, losing weight, and exercising can keep your blood pressure under control. And if you do have prehypertension or hypertension, it can lower your pressure as much as—or more than—prescription drugs. This booklet shows you how. 

11 Replies to “5 things you should know about high blood pressure”

  1. This is perfect, accurate, succinct and highlights some of the things many people don’t recognize – that pre-hypertension needs to be treated! And the AMA and best practices needs to include this as a diagnosis, separate from hypertension.

  2. Very informative article. Most people would not be aware of these guidelines and ways of lowering their BP.

  3. Very good article and good dietary advice for treating and preventing hypertension. My only concern is that your “What Works” table really underestimates the relative import of some of those diet & lifestyle factors. The DASH diet appears to be far more important than sodium reduction for lowering blood pressure (BP). If you look at the DASH-Sodium data BP declined by an average of 6.7/3.5mmHg when sodium dropped from about 3300 to 1500mg/day while switching to the DASH diet from a typical American diet without reducing sodium only reduced BP by an average of 5.9/2.9mmHg. And this was only a short term study. Over the long term nearly everyone who consumes a diet with 2400mg or more of sodium develops elevated BP. Over the long term almost everyone who does regular exercise and eats a high salt diet develops high BP but people who eat less than 1200mg of sodium a day see very little or no rise in BP with age and very few end up with high BP. And while exercise can help lower BP in the short term almost everyone who exercise even a lot and consumes a diet high in salt ends up with high BP but again even fairly sedentary people who consume a healthy DASH-type diet very low in salt (<1200mg/day) can get off their BP-meds and still better control their BP than with drugs and a typical American diet even with lots of exercise. Ideally one should do everything that works but it is important to understand their relative import and added salt is likely the biggest culprit when it comes to promoting elevated BP.

    1. The one dietary factor not explicitly mentioned in the article is increased potassium ingestion via higher potassium foods. This is likely why the DASH diet results in lower BP, since fruits and vegetables (two of the mainstays of the DASH diet) generally are high in potassium, particularly relative to their sodium content.

      1. Denis – Certainly agree that potassium intake helps lower BP and mitigates (but not close to eliminating) the hypertensive effect of added dietary salt above about 1200mg/day. Chinese farmers who consume a lot of vegetables and so have a very high potassium intake still develop elevated BP and most have hypertension by the time they hit their 70s. But there are other factors besides potassium such as adequate magnesium and calcium that also tend to reduce the hypertensive effects of too much salt. Of course, if someone follows a DASH-style diet they will likely get plenty of those three cations and if they also limit dietary salt most can get off some and many will get off all their BP-drugs. Indeed, if one does not reduce BP-drugs and adopts a healthy low-salt DASH diet it is possible those drugs will actually cause some potentially serious toxic effects so it is wise to work with an MD who is knowledgeable about reducing BP meds to avoid problems on a healthy low-salt diet and exercise program

      2. James, yes, I am aware of the need for the other minerals you mentioned. Other factors come into play as well, but I chose to limit my reply to potassium to keep my reply concise.
        Perhaps I should have written “This is a major reason (but not the only one) why the DASH diet results in lower BP,…”
        Yes, working with an MD or DO is generally advisable, though many physicians have a suboptimal knowledge of nutrition and the intricacies of how it plays a role in hypertension (as well as many other diseases). I always encourage patients to learn as much about their condition(s) as possible (from reliable sources, of course) so they can be true partners in their health care.

  4. Great article! I remember when I was borderline for high blood pressure. My doctor put me on meds and I was determined I was going to change that. I added more exercise, changed my diet, and by the next doctors visit, I was taken off of the meds. My blood press down and I felt great.

  5. It is very important to read labels on all prepared food products even those that seem healthy at first glance. Trader Joe, for example, puts a ton of sodium in almost everything they freeze or package because they don’t use artificial preservatives which they think are worse.. Prepared soups everywhere are a major culprit. As are restaurant foods I don’t have high blood pressure but when I stopped buying salted nuts and chips it dropped to 110 . ( I forget the other number but it was lower too) Salt really does make a diffetence, at least it did for me. And those numbers are based on two separate readings several months apart, both arms. I’m almost 73, not overweight, and exercise a lot.

  6. I plan on printing this article (plus some others) to bring to my doctor’s office. I have been asking about my rising blood pressure (usually around 130+/78-84ish). My doctor doesn’t believe it needs treatment. I exercise at least 4x a week (trail running). I don’t add salt to my meals and don’t eat many packaged foods. I try to reduce stress in my life and don’t drink alcohol. I am, however, about 15 lbs overweight and can’t seem to lose it (51 years of age, right in the midst of perimenopause). I do have a family history of heart issues. My dad died at 50 of a massive heart attack and my mom has had angina and is on blood pressure medicine. My two older siblings have seen their numbers increase as they age. But still…my doctor won’t do anything to treat me.

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