High Blood Pressure: Can We Talk?
High blood pressure is surprisingly common, uncommonly stealthy, and potentially deadly. It’s also highly treatable—you just have to know you have it first.
Silence is often thought of as golden. But when it comes to high blood pressure—a common and potentially deadly condition dubbed “The Silent Killer” for its tendency to sneak up on sufferers with no warning signs or symptoms—silence is the darkest, most dangerous aspect of the disease.
“High blood pressure greatly elevates the risk of heart attack and stroke, two of the top five leading causes of death in Americans,” says Vincent M. Figueredo, MD, Associate Chair of Cardiology at Einstein Medical Center and director of the hypertension specialty clinic there. “Yet it is deceptively quiet. You can have mild to moderate high blood pressure for years—even decades—before it becomes an emergency. Only then will it speak to you with any symptoms.”
By that time, it might be too late—which is why we’re talking out about it now.
Talking point #1: High blood pressure is incredibly common. The next time you attend a meeting or sit in a movie theater, look to the person sitting on your left and on your right; odds are, one in three of you has high blood pressure.
In the United States, 77.9 million adults have high blood pressure. And projections show that by 2030, the prevalence of hypertension will have risen 7.2 percent higher. Yet, because high blood pressure tends to creep in quietly, it can go unnoticed. In fact, according to the National Nutritional Health and Examination Survey (or NHANES, a series of surveys begun in the early 1960s), nearly 20 percent of people with high blood pressure are in the dark—they don’t even suspect they have it. Fewer still know precisely what it means.
Blood pressure is, actually, exactly what it sounds like: the pressure with which blood, pumped from the heart, pushes against the walls of the arteries. As a measure, it’s expressed as a ratio: systolic pressure (blood pressure when the heart beats while pumping blood) over the diastolic pressure (blood pressure when the heart is at rest between beats).
Normal, healthy blood pressure for adults is systolic pressure of 120 mmHg (millimeters of mercury) and diastolic pressure below 80—or, any reading below 120/80 mmHg. Anything above 140/90 is considered high blood pressure.
High blood pressure—also called hypertension—occurs when the force of blood through the arteries is higher than it should be, either simply due to age (as you get older, blood pressure tends to rise because your blood vessels tend to become less elastic) or an underlying condition like obstructive sleep apnea, kidney disease, thyroid problems, diabetes, and obesity. “When the force of blood within them rises, arteries become more vulnerable and eventually weaken, leaving sufferers susceptible to heart attacks and stroke,” says Dr. Figueredo.
A higher percentage of men than women have high blood pressure until age 45. From ages 45 to 54 and 55 to 64, the percentage of men and women is similar; after that, a much higher percentage of women than men have high blood pressure.
Talking point #2: High blood pressure is potentially deadly. The numbers tell a grave story: According to NHANES, 69 percent of people who have a first heart attack, 77 percent who have a first stroke, and 74 percent who have congestive heart failure all have blood pressure higher than 140/90. “It puts you at risk for some of the most deadly conditions there are,” says Dr. Figueredo.
Talking point #3: High blood pressure is highly treatable. You just have to catch it first. “Everyone should have their blood pressure checked annually and in both arms by their primary care physician,” says Dr. Figueredo. “Small differences in blood pressure in the arms are perfectly normal. But a difference of 10 points or more in systolic blood pressure could signal the presence of artery-clogging plaque in the vessel that supplies blood to the arm with lower blood pressure—a sign of peripheral artery disease [cholesterol-clogged arteries anywhere in the body other than the heart] and a loud warning sign of heart attack and stroke.”
If you find that you do have high blood pressure, Dr. Figueredo recommends having it rechecked every three months as you amend your lifestyle to try to tamp down on your pressure. (Make certain your doctor checks it in the arm in which your pressure was highest, since that’s now your baseline.)
The most proven blood pressure lowering strategies:
- Quitting smoking (imperative)
- Exercising regularly (also imperative)
- Losing weight (also key)
- Easing stress, and
- Limiting alcohol consumption.
If after three to six months your blood pressure hasn’t lowered to a safe level, Dr. Figueredo strongly suggests talking to your doctor, who might prescribe blood pressure-lowering medication.
Talking point #4: High blood pressure is sometimes persistent. That’s even despite medication. If yours continues to remain high, don’t give up. Head to a hypertension specialty clinic such as Dr. Figueredo’s at Einstein.
“The reason our clinic and others like it exist is that there are patients in whom high blood pressure is extremely difficult to manage,” he says. “These patients, who are at very high risk of heart attack and stroke, can be on literally a handful of medicines at once. It often takes a hypertension specialist with state-of-the-art tools like applanation tonometry, (a device that allows physicians to assess a patient’s central aortic pressure or blood pressure as it comes out of the heart, a measure that’s more predictive of future cardiac problems than an arm reading), which we have at Einstein, to figure out the drug combinations that work. But figure them out, we do.” And that’s definitely worth talking about.