Have High Blood Pressure?

Stress, couch-surfing, even your DNA, can raise your hypertension risk. A top doctor reveals how to prevent the chronic condition and what to do if you have high blood pressure. Read on for her expert advice. Plus, how well do you understand hypertension? Take our quiz to find out…

Could you have high blood pressure? As many as 50 million Americans have hypertension, according to the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 8: Eighth Report).

Yet, at least 15 million – 30% – of them don’t know it.

That’s because “in the early stages, hypertension often is asymptomatic,” says Suzanne Oparil, M.D., director of the Vascular Biology and Hypertension Program at the University of Alabama, Birmingham. “Since many people are unaware they have high blood pressure, the disease often goes untreated.”

Blood pressure is determined by the volume of blood the heart pumps and the amount of resistance to blood flow in the arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

If the force of the blood against artery walls gets high enough, it can lead to stroke, heart attack, aneurysms and kidney failure.

A normal blood pressure reading is 120/80 or lower. Blood pressure between 120/80 and 139/89 is called "pre-hypertension.” You have high blood pressure if your reading is 140/90 or above.

Here’s what the numbers mean: The top number, or your systolic reading, measures the pressure in the arteries when the heart beats. The lower number, your diastolic reading, measures the pressure in the arteries between heartbeats, when the heart is resting.

More than 90% of cases have no obvious medical cause for hypertension, although poor diet, lack of exercise, obesity and stress increase your hypertension risk.

The good news: If hypertension is diagnosed and treated early, it’s a manageable condition, Oparil says.
“Lifestyle changes, especially losing weight, can prevent and treat hypertension in the early stages,” she says. “Later, patients require a combination of lifestyle changes and antihypertensive drugs to manage the disease.”

In this exclusive Lifescript interview, Oparil discusses the latest in preventing and treating hypertension.

Why should young or middle-aged women be concerned about blood pressure readings?
Hypertension is more prevalent in older people than younger, but it affects both sexes. In fact, it’s more common in elderly women than elderly men.

So women, especially as they reach middle age, should be concerned about their blood pressure and have it checked once a year, even if they believe it’s normal.

If you have high blood pressure, is it genetic or caused by lifestyle?
Both figure equally. Genetics cause about 50% of the tendency to develop hypertension; the rest is due to factors like a sedentary lifestyle, smoking, stress, a bad diet, diabetes and obesity.

But in 90% of hypertension cases, there is no specific identifiable cause. This is referred to as essential hypertension.

Often, since no one specific factor causes it, there’s no one specific cure either. [Treating essential hypertension] often involves trying several approaches at once.

Obesity is a big factor, correct? More than 85% of hypertension cases occur in people with a body mass index (BMI) greater than 25.
Yes, that’s partly because obesity strains your circulatory system. It’s also due to hormones and inflammatory substances produced by adipose [fat] tissue. Losing weight is the single most effective thing you can do to lower your [hypertension] risk or manage the disease.

If I’m at a healthy weight, does this mean I don’t have to worry about hypertension?
An ideal weight doesn’t fully protect against hypertension. Lean, fit people need to have their blood pressures checked just like everyone else. More than 90% of hypertension cases don’t have an obvious cause behind them.
Does my diet increase or decrease my hypertension risk, even if I’m not overweight?
Diet is a major factor. A National Institute of Health (NIH) initiative, called Dietary Approaches to Stop Hypertension (DASH), recommends a diet full of fruit, vegetables and low-fat dairy products to lower blood pressure.

The DASH diet limits saturated fats, cholesterol and sodium and suggests eating whole grains, fish, poultry and nuts. [For a complete overview of the eating plan, as well as recipes, click here.

If I have high blood pressure, what precautions, if any, should I take when exercising?
Assuming that you don’t have underlying heart disease, increased physical activity is one of the best ways to reduce blood pressure and cut your probability of developing cardiovascular complications.

[But] your doctor might advise you to avoid heavy weight-lifting, since straining sometimes causes major increases in blood pressure.

Conventional wisdom says limiting salt intake helps you avoid hypertension. But a 2011 Journal of the American Medical Association (JAMA) study called this into question. Your thoughts?
Limiting salt is much more effective in older and obese people than in those who are younger, slim and healthy.

In general, it’s more important to keep an optimal weight and stay physically active than to focus on the amount of salt in your diet.

What about stress? Another 2011 JAMA study showed that cognitive behavioral therapy reduced the risk of a second coronary event by as much as 30%. Does stress reduction lower hypertension risk as well?
It’s been shown that chronic stress – caused by psychosocial factors like marital or work unhappiness or money problems – is a major factor in cardiovascular disease.

Chronic stress can also be invisible – since you feel it every day, you may not notice it or perceive it as stress.
In temporary stress – the kind triggered when you’re in danger – stress hormones such as cortisol and adrenaline rise and cause your blood pressure to elevate, getting you ready for the flight-or fight-response. That’s a temporary response to a temporary situation. Presumably when the danger passes, your blood pressure returns to normal.

But [with chronic] stress, the result may be a chronic elevation of high blood pressure, and the risk for heart attack or stroke also rises.

If you have high blood pressure, are you at risk for dangerous complications, such as aneurysms, metabolic syndrome, heart attack and stroke?
Hypertension can progressively damage organs throughout the body – the brain, heart and kidneys – thus raising your risk for diseases you might not think about, such as dementia and atherosclerosis.

You can avoid these conditions by having your hypertension diagnosed and treated early with a combination of lifestyle modification and antihypertensive drugs.

Are there different stages of hypertension? If so, are they treated differently?
In the U.S., hypertension is divided into two stages:

Stage 1 [blood pressure reading of 140/90-159/99] is less severe and treated with lifestyle changes and one drug.

If the treatment at Stage 1 fails to lower blood pressure enough, the patient is considered to have Stage 2 hypertension [160/100 or higher] and a different class of medication might be added.

Different classes of hypertensive drugs work in different ways, so one drug may complement another. Some patients require a third drug too.

Are there any new advances in medication?
Many people, especially those who are older, obese or have complicating conditions like diabetes or kidney disease, require two or more hypertensive medications to control their high blood pressure. So the trend is to combine them into a single tablet to ensure they’re taken together in the right way. This lowers blood pressure more effectively.

Should blood pressure medication be taken at any particular time of day or with food or a specific beverage?
Each medication is different and each has its own protocol. Talk to your health-care provider or pharmacist to make sure that you take it correctly.

Also ask about any possible adverse side effects whenever a new medication is prescribed.

If I have high blood pressure when I visit the doctor, does that one elevated reading mean hypertension?
No. A hypertension diagnosis requires two elevated readings made at different times and recorded under defined conditions. Guidelines do not recommend making the diagnosis based on a single reading.

If I have high blood pressure, should I get a blood pressure machine and monitor my blood pressure myself?
These machines can be useful. If you have one, take your blood pressure once or twice a day and keep a diary of the time of day and what you were doing just before you took the measurement.

Then bring that diary to your next doctor visit, because this can be valuable information in your hypertension management.

But [home monitoring may not help] if taking your own blood pressure makes you anxious. You may get a series of false high readings and cause yourself, your family and health-care provider a lot of unnecessary stress. Use your best judgment.

Can children get high blood pressure? What can I do now to keep this from being a future problem in my family?
Yes, children should have their blood pressure checked as part of their regular pediatric visits.

It’s especially important to monitor blood pressure in children who have any of the unusual secondary causes of hypertension, like kidney disease. And children can lower their [hypertension] risks through the same lifestyle choices as adults – keeping their weight in the optimal range, eating a healthy diet and getting lots of exercise.
For more information, visit our Hypertension Health Center.

How Well Do You Understand Hypertension?
One in three people have hypertension. It often has no warning signs, but left untreated, can be deadly. In fact, high blood pressure kills nearly 60,000 people a year. Yet it’s usually easily controlled with diet and/or medication.