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Everything You Need To Know About High Blood Pressure (Hypertension)
You may be more likely to have high blood pressure due to your genetics, age, and whether you have certain health conditions. Treatment may include medication and lifestyle changes.
Your blood pressure measurement takes into account the amount of blood passing through your blood vessels and the amount of resistance the blood meets while the heart is pumping.
High blood pressure, or hypertension, occurs when the force of blood pushing through your vessels is consistently too high. In this article, we'll cover the basics of hypertension, including its symptoms, causes, how it's treated, and more.
Narrow arteries create more resistance for blood flow out of the heart. The narrower your arteries, the more resistance there is, and the higher your blood pressure will be. Over the long term, the increased pressure can cause health issues, including heart disease.
Hypertension is quite common. Since guidelines changed in 2017, nearly half of American adults have high blood pressure, according to the American Heart Association.
Hypertension typically develops over several years, usually without causing any symptoms. But even without symptoms, high blood pressure can cause damage to your blood vessels and organs, especially the brain, heart, eyes, and kidneys.
Early detection is important. Regular blood pressure readings can help you and a doctor notice any changes. If your blood pressure is elevated, a doctor may have you check your blood pressure over a few weeks to see if the number stays elevated or falls back to typical levels.
Treatment for hypertension includes both prescription medication and healthy lifestyle changes. Without treatment, it could lead to health issues, including heart attack and stroke.
Your blood pressure reading consists of two numbers:
Five categories define blood pressure readings for adults:
A blood pressure reading is taken with a pressure cuff. It's important to have a cuff that fits for an accurate reading. An ill-fitting cuff may deliver inaccurate readings.
Blood pressure readings are different for children and teenagers. Ask your child's doctor for the healthy ranges for your child if you need to monitor their blood pressure.
There are two types of hypertension. Each type has a different cause.
Essential (primary) hypertensionEssential hypertension, also called primary hypertension, develops over time. Most people have this type of high blood pressure.
A combination of factors typically play a role in the development of essential hypertension:
Secondary hypertension often occurs quickly and can become more severe than primary hypertension. Several conditions that may cause secondary hypertension include:
Secondary hypertension may also be a side effect of certain medications.
Hypertension is generally a silent condition. Many people won't experience any symptoms. It may take years or even decades for the condition to reach levels severe enough that symptoms become apparent. Even then, some people may attribute these symptoms to other causes.
Getting regular blood pressure readings is the best way to know if you have hypertension. Most doctors' offices take a blood pressure reading at every appointment.
Symptoms of severe hypertension, such as in a hypertensive crisis, can include:
Read more: "Symptoms of High Blood Pressure (Hypertension)"
Because hypertension is often a silent condition, it can cause damage to your body for years before symptoms become obvious. Without treatment, you may face serious, even fatal, complications.
Hypertension can damage your arteries, making them tougher, tighter, and less elastic. This damage makes it easier for deposits to collect in your arteries and restrict blood flow through your body, affecting multiple systems.
Complications of hypertension include:
Read more: "The Effects of Hypertension on the Body"
Diagnosing hypertension is as simple as taking a blood pressure reading. Most doctors' offices check blood pressure as part of a routine visit. If you don't receive a blood pressure reading at your next appointment, feel free to request one.
If your blood pressure is elevated, a doctor may request more readings over the course of a few days or weeks. Doctors rarely diagnose hypertension after just one reading. They'll need to see evidence of a sustained problem.
That's because your environment can contribute to increased blood pressure, like the stress you may feel by being at the doctor's office (known as "white coat syndrome"). Also, blood pressure levels change throughout the day.
If your blood pressure remains high, a doctor will likely conduct more tests to rule out underlying conditions. These tests can include:
If a doctor diagnoses you with primary hypertension, lifestyle changes may help reduce your high blood pressure. If lifestyle changes alone aren't enough, or if they stop being effective, they may prescribe medication.
Medications for hypertensionMany people go through a trial-and-error phase with blood pressure medications. A doctor may need to try different medications until they find one or a combination that works for you.
Some of the medications used to treat hypertension include:
Read more: "11 Common Blood Pressure Medications"
Treating secondary hypertensionIf a doctor discovers an underlying issue causing your hypertension, treatment will focus on that other condition. For example, if a medication you've started taking is causing increased blood pressure, your doctor will try other medications that don't have this side effect.
Sometimes, hypertension is persistent despite treatment for the underlying cause. In this case, a doctor may work with you to develop lifestyle changes and prescribe medications to help reduce your blood pressure.
Treatment plans for hypertension often evolve. What worked at first may become less useful over time. Your doctor will continue to work with you to refine your treatment.
High blood pressure, also known as hypertension, is a common health issue in the United States. Treatment for hypertension varies depending on factors such as the severity of your condition and which medications a doctor thinks will work best for you.
In many cases of hypertension, lifestyle changes can be powerful tools for managing — or even reversing — high blood pressure. These changes include incorporating more nutritious fruits and vegetables into your diet, getting more physical activity, limiting your sodium intake, and limiting your alcohol consumption.
Because hypertension often presents with no symptoms, checking your blood pressure regularly is important. Severe hypertension can cause serious health issues, so the sooner you receive a diagnosis, the sooner you can begin to manage it.
Dear Doctor: I'm Confused About What's Considered 'normal' Blood Pressure
DEAR DR. ROACH: I have been confused about what normal blood pressure is for me (or anyone). I know there are some issues on what normal is today, but let us say that normal is 120/80 mm Hg. Does this mean that 110/90 mm Hg, 130/70 mm Hg, or 150/50 mm Hg is also normal? Is there any significance of the ratio of systolic/diastolic blood pressure? -- L.P.
ANSWER: Because so many people have high blood pressure, and the consequences of untreated or poorly treated high blood pressure include a risk for heart attack and stroke, it's critically important to understand this thoroughly.
For a young, healthy person, the lower the blood pressure, the lower the risk of blood vessel damage that leads to these dreaded complications of heart attack and stroke. I routinely see people with blood pressures of 90/60 mm Hg who are just fine (although they are a bit more likely to faint).
But for middle-aged and older people, we define normal blood pressure as when the systolic (first or top number) pressure is less than 120 mm Hg and the diastolic (the second or bottom number) is less than 80 mm Hg. Elevated blood pressure is when the systolic pressure is between 120-129 mm Hg and the diastolic pressure is less than 80 mm Hg. It's considered hypertension when the systolic number is 130 mm Hg or greater, or the diastolic number is 80 mm Hg or greater. So, all of the readings you proposed are hypertension, not just elevated blood pressure.
Of course, the higher the reading (in general), the higher the risk of damage to the blood vessels, and after some years, the higher the risk of heart attack or stroke. It's not the ratio of the systolic and diastolic numbers that is of interest; it's the difference between them (also called the pulse pressure). So, with the numbers you gave, the pulse pressures are 20, 60 and 100. Independent of blood pressure levels, a higher pulse pressure confers additional risk to the person, mostly because very stiff blood vessels cause a high pulse pressure. Different types of blood pressure medicines affect pulse pressure differently.
DEAR DR. ROACH: Is a platelet count of 135,000 low or in the normal range for a 76-year-old male in good health with no signs of abnormal bruising or bleeding? -- P.R.
ANSWER: The normal range for a platelet count is 150,000-450,000 per microliter, so 135,000 is just below the lower limit of normal. However, it's quite rare to have abnormal bleeding with a platelet count like this, even under stress like a surgical procedure. About 2.5% of the healthy population will have a platelet count below 150,000, so a level of 135,000 may not represent disease at all. Typically, the risk of spontaneous major bleeding becomes high when platelet levels drop below 30,000.
The most common cause of low platelets in older adults is an immune-mediated condition called "immune thrombocytopenia," but there are many possible causes, including medications, bone marrow diseases, and liver disease. For a 76-year-old, if repeat blood counts show that the platelet count is stable in the 100,000 range, most experts would not do further testing in absence of any symptoms.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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Your Alzheimer's Risk Could Be 42% Higher If You Leave High Blood Pressure Untreated
A new study published online on August 14, 2024, in Neurology found that people ages 60 and above with untreated high blood pressure may be at greater risk of Alzheimer's disease.
This was in comparison with individuals whose high blood pressure was currently being treated or had been treated in the past. A comparison was also made with people without high blood pressure.
Alzheimer's disease affects nearly 7 million people in the U.S. Alone, according to the Alzheimer's Association, and it is the most common type of dementia, making up an estimated 60% to 80% of cases.
People who have Alzheimer's disease experience problems with memory and cognition that are severe enough to interfere with their daily lives. Aging is its number one risk factor.
The study's goal was to examine how untreated high blood pressure affects people's risk of this very common disease.
For the study, the research team examined data from more than 31,000 people. The average age of the study participants was 72.
During an average follow-up period of four years, a little over 1,400 of them went on to develop Alzheimer's disease.
After looking at various factors — such as blood pressure readings, high blood pressure diagnosis, and whether people used medications to treat their blood pressure — the team found that 9% were not treating their condition, 51% were using medications, 36% did not have high blood pressure, and 4% were not sure of their status.
After adjusting for any other factors that could influence the outcome, it was found that untreated high blood pressure was associated with a 36% increased risk of Alzheimer's disease compared to those who did not have high blood pressure.
Additionally, the group had a 42% increased risk for Alzheimer's when they were compared with those who were treating their high blood pressure with medications.
Per the study authors, this implies that treating high blood pressure as you age could play a vital role in reducing your Alzheimer's risk.
John Lowe, MD, a physician at Restore Care, who was not involved in the study, explained how high blood pressure (hypertension) might be associated with Alzheimer's disease.
"Hypertension can cause injury to the brain's blood vessels, especially the tiny ones, and this may lead to inadequate blood supply to important parts of the brain," he said.
When the brain does not get enough blood, this can lead to decreased functioning, which may manifest as cognitive decline, according to Lowe.
"Another thing is that high blood pressure is a risk factor for vascular dementia, which can occur alongside Alzheimer's disease and make it worse," he said.
John Higgins, MD, a professor and cardiologist at UTHealth Houston, who was also not involved in the study, pointed to several steps besides using medications that can reduce your elevated blood pressure.
One is to reduce your salt intake. Higgins advises looking into the DASH (Dietary Approaches to Stop Hypertension) diet. However, a plant-based or Mediterranean diet can also be good, he said.
To make things easier, you'll want to remove the saltshaker from your table and check nutrition labels so you can remove high-salt foods from your diet.
Potassium can also help lower blood pressure, so you can try using salt substitutes, which contain potassium, to bring down your sodium intake.
However, you'll want to check with your doctor first since potassium can be problematic for those with conditions like kidney disease, heart disease, liver disease, and diabetes.
Higgins also suggests eating grilled or steamed food rather than smoked, processed, or fried since they will contain less salt.
Additionally, he advises getting enough exercise. Aim for ≥150 minutes per week, he said.
Also, breathing exercises, meditation, and yoga are all great ways to reduce your stress, according to Higgins.
"Alzheimer's disease reduction is multidimensional and requires addressing numerous lifestyle and health factors," said Lowe.
Among the factors you'll want to consider are:
Cognitive stimulation. "Participating in mentally engaging activities such as puzzles, reading, and acquiring new skills may help create a cognitive reserve that could postpone symptoms of Alzheimer's," he said.
Physical activity. Lowe noted that exercise can pull double duty, helping with blood pressure management and overall brain health. "It boosts blood flow toward the brain, and in this way, it can reduce amyloid plaque burden," he explained.
Heart health. Lowe said that managing your cardiovascular risk factors—like high blood pressure, diabetes, and high cholesterol — also plays a part in protecting your brain and reducing your risk of Alzheimer's.
Healthy diet. "Eating a diet rich in antioxidants, omega-3 fatty acids, and low saturated fats may lower your risk of developing Alzheimer's," he said, noting that the Mediterranean diet, which is high in these nutrients, has been found to protect against cognitive decline.
Social engagement. "Keeping strong social ties with others while participating in activities together helps improve mental health, which may then bring down the risk of developing Alzheimer's," Lowe concluded.
A new study has found that untreated high blood pressure was associated with an increased risk for Alzheimer's disease.
Experts say that over time, high blood pressure can cause damage, leading to decreased circulation in the brain. This puts people at risk for cognitive decline and dementia.
In addition to taking prescribed medications, people can make lifestyle changes such as eating a healthy diet, exercising, and managing stress to help reduce their risk of high blood pressure.
Protecting against Alzheimer's requires being aware of and managing the many factors that influence its risk. In addition to eating a healthy diet, exercising, and managing your cardiovascular risk factors, keeping your mind active and remaining socially engaged can help stave off dementia.
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