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Hypertension: Answering Your Questions About the “Silent Killer”—Commentary

09/02/17 George L. Bakris, MD, Professor of Medicine, University of Chicago School of Medicine

More than 75 million Americans have high blood pressure as a result of the disease hypertension. That’s more than the populations of Texas, Florida, New York, and New Jersey combined. Here’s another way to look at it: one in three American adults have high blood pressure. Hypertension significantly increases the risk of all kinds of conditions, from a heart attack to kidney disease.

That’s the bad news. The good news is, with the right habits and input from your doctor, you can control your blood pressure and significantly reduce the risk of these dangers. Since February is Heart Health Month, let’s answer some of the most common questions patients have about high blood pressure, from why it’s known as the silent killer to why some people’s blood pressure rises when they visit the doctor’s office.

1. What is a healthy blood pressure level?

A healthy blood pressure reading for a 40-year-old individual is 120/80 mm Hg (millimeters of mercury). But what do those two numbers mean? Systolic pressure (top number) is a measurement of pressure in the arteries when the heart contracts. Diastolic pressure (bottom number) is a measurement of pressure in the arteries just before the heart contracts.

High blood pressure is defined as a systolic pressure at rest of 140 mm Hg or more, a diastolic pressure at rest of 90 mm Hg or more, or both.

Our blood pressure changes all the time—it rises and falls throughout the day and changes throughout our lives. Just because your blood pressure is elevated for one reading doesn’t mean you have hypertension. It’s best to average the blood pressure readings several times in several different settings.

2. How do I know if I’m at risk?

Hypertension is called the silent killer because it can persist for years without any noticeable symptoms, and it is responsible for 1,100 deaths a day in the United States alone. While most people have no symptoms, some people may notice a pounding headache or a general sensation of not feeling well.

High blood pressure becomes much more common as we get older, affecting about two in three Americans over the age of 65. And even if a person has normal blood pressure at age 55, he or she still has a 90 percent chance developing hypertension if they live to age 80.

In addition to age, a strong family history of hypertension increases your risk of developing elevated blood pressures in your 30s and 40s. If your mother, father, aunts, or uncles are being treated for high blood pressure, you may be at an increased risk. Other aggravating factors are obesity, a sedentary lifestyle, excess alcohol use, stress, and a diet that is high in salt.

3. How should I test my blood pressure?

An accurate reading is the first step in determining if your blood pressure is under control. Before your blood pressure is checked at the doctor’s office, sit with your legs uncrossed and your back fully supported and rest for five minutes. Then roll up your sleeve and rest your arm on a table or arm rest. Your doctor or nurse will use a cuff that wraps around the arm once, then two-thirds of the way again. Ideally the room should be silent and you should not be talking, listening to music or watching TV.

You can accurately check your blood pressure at home by using a reliable testing machine (ask your doctor for a recommendation) and measuring in the appropriate position described above. An average person’s blood pressure is actually highest early in the morning when waking up, so that is the best time to test. Skip the blood pressure testing machines at the grocery store because they’re not as reliable as other methods.

For some people, simply walking into a doctor’s office is enough to create a spike in blood pressure. This disorder, often dubbed white coat hypertension, can be dangerous if it leads to overtreatment in people whose blood pressure is not elevated when they’re not in the doctor’s office.

4. How can I control my blood pressure?

Getting a handle on hypertension is easier said than done. There is some controversy among physicians on what the ideal BP should be, so talk to your doctor about your case specifically.

Most doctors start treatment by encouraging lifestyle changes. This means exercising more, eating more fruits and vegetables, and reducing salt and alcohol intake. Reducing salt is especially tricky for a lot of people. Cheese, many soups, deli meats, and takeout meals are often very high in sodium. Additionally, sleep quality is very important. Make sure you’re getting at least six hours of uninterrupted sleep a night and, if necessary, get screened for sleep apnea. If lifestyle changes aren’t having an impact, doctors prescribe medications.

If high blood pressure runs in your family or if you’re over 40, don’t wait for symptoms to appear—have your blood pressure checked at least once a year. If you’ve been diagnosed with hypertension, it’s essential that you take your medications correctly and make the necessary lifestyle changes to keep your blood pressure under control. Remember: medications control and manage your blood pressure, but they do not cure it.