Increasing age is a major risk factor for high blood pressure, also called hypertension. Nearly two out of every three Americans over 60 have it, and for people over the age of 80, the number approaches three out of every four. But age isn't the only factor, and about one-third of US adults ages 40 to 59 can now be classified as having high blood pressure. And the prevalence is increasing across all age groups and ethnicities, according to government data.
Hypertension is not inevitable, however. There are steps you and your health care providers can take to help you avoid it, as well as many effective ways to monitor and treat it. That's important to do, since high blood pressure damages the heart, blood vessels, kidneys, brain, and other organs and can lead to heart attack, stroke, heart failure, and kidney failure. It also increases the risk for dementia.
Here are answers to key questions about hypertension.
Symptoms and stages
Q. What are the symptoms of high blood pressure?
High blood pressure usually has no symptoms, and even a person with very high blood pressure may feel okay. This is why it’s called a “silent killer” and why many people with hypertension don't take medication. Nosebleeds, headaches, breathlessness, a chronically red face, or angry outbursts are not symptoms of hypertension (though anger does temporarily raise blood pressure, one reason that chronically angry people are at higher risk for cardiovascular disease). A heart attack or stroke may actually be the first sign of high blood pressure. The only way to know if you have high blood pressure is to be tested.
Q. How is high blood pressure defined?
Blood pressure is expressed as two numbers, for example, 120/80. The first number is called systolic pressure. It indicates the force of blood in the arteries when the heart beats. Diastolic pressure, the second number, is the force of blood between heartbeats while the heart refills. Systolic pressure is the one that usually increases with age. But both numbers are important. Persistently high diastolic pressure can lead to heart failure.
Whether your blood pressure is considered high or normal depends on these two numbers. According to 2017 guidelines from the American College of Cardiology and American Heart Association (ACC/AHA), the stages for blood pressure:
Normal: less than 120 systolic and less than 80 diastolic
Elevated blood pressure: 120-129 systolic and less than 80 diastolic
Stage 1 hypertension: 130-139 systolic or 80-89 diastolic
Stage 2 hypertension: 140 or higher systolic or 90 or higher diastolic
When the numbers for systolic and diastolic pressure fall into different categories, the higher number is used to classify your blood pressure.?
Diagnosing High Blood Pressure
Blood pressure generally peaks in the early morning hours and can go up and down multiple times in a single day, which is why ambulatory monitoring is the best way to measure it.
Q. Why are the stages of hypertension important?
Guidelines for preventing and treating hypertension are developed by expert panels and endorsed by government and professional organizations to help your doctor decide how best to help you control your blood pressure. Guidelines draw on current research and understanding to recommend strategies for treating and preventing high blood pressure, such as medication and lifestyle adjustments. What’s recommended for you is determined largely by your blood pressure category.
For example, if you are in the "elevated blood pressure" category, your doctor will likely recommend that you have your blood pressure checked more frequently. The doctor will also likely tell you that you should take steps to lower it. For instance, you may need to cut down on sodium, follow a healthy diet, lose weight if you are overweight, and get regular aerobic exercise.
Treating high blood pressure
Q. When is a doctor likely to prescribe medication for high blood pressure?
People with hypertension will need to start taking medication if lifestyle changes aren't enough to lower the pressure. There are many safe and effective drugs for hypertension. You will need the advice of your doctor as well as careful follow-up to make sure the medicine is working and to monitor any side effects.
According to the latest ACC/AHA guidelines, if you have stage 1 hypertension, you are a candidate for medication only if lifestyle modification doesn’t help enough and if you already have cardiovascular disease—or if you have a 10-year cardiovascular risk of at least 10 percent as evaluated by an online calculator. Since age is such a big factor in the calculator, nearly everyone over 65 will have a calculated risk that high. If you have stage 2 hypertension, you’ll be advised to take medication (usually two drugs from different classes), along with making lifestyle changes.
Q. Will I have to take medicine the rest of my life?
This depends on how high your blood pressure is and how well you can bring it under control. If it’s mildly elevated and you follow a healthy diet (such as the DASH plan, see below), lose excess weight, get regular exercise, and quit smoking, you may be able to cut your dose or even do fine without medication. But never reduce your dosage or stop taking medicines on your own. Talk with your doctor first and make sure you have frequent ongoing checkups.
Most people on medications for high blood pressure must take them indefinitely. If your pressure has been adequately reduced with medication, that means it's working. It also means the pressure is likely to rise again if you stop taking your medication.
Q. If I am on blood pressure medication, how low should my doctor and I aim for?
The current ACC/AHA goal is for people with hypertension to lower their blood pressure to below 130/80, which can be challenging. In contrast, guidelines from the American College of Physicians and American Academy of Family Physicians set the goal at below 150/90 for people over 60 at average or low cardiovascular risk, and 140/90 for those at high risk. There are no magic numbers for everyone, nor any one-size-fits-all treatment, so working with your health care provider is crucial.
Whatever goal you aim for, don’t forget that lifestyle changes, such as losing excess weight and exercising, can help you get there.
Q. Can dietary supplements help prevent or control hypertension?
No supplement is known to prevent or treat high blood pressure. On the other hand, a diet rich in fiber, potassium, magnesium, and calcium can help prevent high blood pressure or keep it under control (this is the basis of the DASH diet). Several studies have singled out low-fat or nonfat dairy products in particular as helping to control hypertension. But the benefits seem to depend on those foods and nutrients being part of an overall healthful diet. Eating isolated nutrients in supplement form isn’t likely to help.
Q. If I control hypertension, is my risk for heart attack and stroke the same as if I always had normal blood pressure?
Controlling hypertension is essential and will substantially reduce your risk of heart attack and stroke. But you may never return to the lowest level of risk. Much depends on how long you had high blood pressure, how high it was, and how well you control it. If, for instance, you had uncontrolled hypertension for many years, you would still be at higher risk for cardiovascular disease than someone who always had normal blood pressure.
Causes and risk factors
Q. Is it normal for blood pressure to rise with stress? ?
There is little evidence that prolonged stress causes hypertension. Blood pressure is created by the pumping of your heart, and it varies depending on your activity level, level of stress, and many other factors. But after it rises for some specific reason, it should go back down. Staying elevated is not normal and should be evaluated by a doctor.?
Conversely, if you have hypertension and your life is stressful, learning ways to reduce that stress may help to lower your blood pressure. Ask your doctor about techniques that can help you manage stress, such as meditation and relaxation exercises.
Q. Does being overweight increase the risk of high blood pressure?
Yes. Thin people can have hypertension, but being overweight greatly increases the risk. Losing even a few pounds can lower blood pressure. Weight loss achieved through a healthy diet and exercise can sometimes control high blood pressure so that drugs are not necessary or are needed in lower doses.
Sleep apnea is a common disorder that causes interruptions in a person's breathing while they sleep. These interruptions result in poor quality sleep that can cause excessive sleepiness during the day. It's a chronic condition that often goes undiagnosed. You may not even know you have it unless your partner or another family member tells you that you snore loudly or is awakened by your fitful breathing during the night.
Untreated sleep apnea is associated with multiple health risks and complications, including high blood pressure. In fact, roughly half of all people with sleep apnea have high blood pressure. In addition, sleep apnea increases the risk for obesity and diabetes, as well as other conditions that can cause or worsen high blood pressure. The good news is that sleep apnea can be controlled. If you've been told you're a fitful sleeper or if you have unexplained daytime sleepiness, talk with your doctor about having a sleep study, which can diagnose apnea.
Sleep apnea is most commonly treated with CPAP, a device that you wear while you sleep and which provides a steady flow of air at high enough pressure to keep your air passages open. A CPAP will help ease your snoring, reduce sleep interruptions, and prevent daytime sleepiness. Studies show that using a CPAP can also reduce blood pressure in some people.
Q. What is the role of salt?
Though the experts continue to argue about salt, it’s clear that a high-sodium diet increases the risk of hypertension, and that a low-sodium diet can not only help prevent hypertension but help control it in some people. Sodium increases blood pressure because it causes your body to hold on to excess fluid. This creates added stress for your heart. The Dietary Guidelines for Americans recommend limiting intake to 2,300 milligrams a day (the amount in about a teaspoon of salt). The American Heart Association says a daily limit of just 1,500 milligrams is desirable. That lower goal makes sense for people with high blood pressure and those at higher risk for it (including black people and all adults over age 50).
The Best Diet for Blood Pressure
Fruits, vegetables, whole grains, and low-fat or nonfat dairy foods are the cornerstones of the DASH (Dietary Approaches to Stop Hypertension) eating plan, which is proven to lower blood pressure.
Most dietary sodium comes not from your salt shaker but rather from processed foods, such as canned soups and sauces and restaurant meals. The only way to keep your sodium intake as low as 1,500 milligrams daily is to eat mostly unprocessed foods such as fruits, vegetables, and meat prepared at home. Unprocessed foods have very little sodium. You can also choose low-sodium brands in the store, and ask for less salt in restaurants. The government is working with chain restaurants and food manufacturers to reduce sodium levels in food.
Q. What about smoking?
Giving up smoking is the single most important step you can take to prevent high blood pressure or lower it if you have it.
Q. What about alcohol?
The advice is the same for people with and without hypertension: If you drink, keep it moderate. For a man that means no more than two drinks daily; for a woman, one drink. People over 65 should drink even less. A drink is defined as 1.5 ounces of 80-proof spirits, 5 ounces of wine, or 12 ounces of beer—all of which contain the same amount of alcohol. However, heavy drinking can raise your blood pressure and increase the risk of cardiovascular disease. If you are taking blood pressure medication, talk with your doctor about possible interactions with alcohol.
Q. Can pain relievers such as aspirin and acetaminophen raise blood pressure?
There’s evidence that all over-the-counter pain relievers—aspirin, acetaminophen, naproxen, and ibuprofen—can cause blood pressure to rise. If you have hypertension and take any of these drugs regularly for pain relief, talk with your doctor about your options. Women taking pain relievers daily may be especially susceptible to a rise in blood pressure. Low-dose aspirin taken for heart health is unlikely to have this effect, but it should be avoided if you have uncontrolled hypertension unless your doctor advises otherwise.
The role of exercise
Q. Can exercise help prevent or control hypertension?
Yes. Aerobic exercise—such as brisk walking, swimming, running, and cycling—reduces blood pressure in healthy people as well as in those who already have hypertension. It’s important to raise your heart rate enough to work up a light sweat. You should exercise 30 minutes on most days. Exercise not only benefits the entire cardiovascular system but also may help you control your weight. Active gardening and housework are not aerobic, but any kind of activity can help somewhat.
Q. What about weight training?
Doctors once warned people against it, since strenuous lifting can cause a temporary spike in pressure. But recent evidence points to benefits. If you have high blood pressure, you should ask your doctor for advice before you start training. A qualified personal trainer can also help.
Q. Is it dangerous for people with high blood pressure to visit high altitudes? To ski?
In healthy people as well as those with hypertension, blood pressure rises somewhat with increases in altitude, but this should be nothing to worry about. However, if you have hypertension and are going somewhere above 6,000 feet, talk with your doctor. You may need a higher dose of your medicine. High blood pressure, if kept under control, should not prevent you from skiing.?
Orginally published April 18, 2016.
Published December 06, 2017