Nearly half of U.S. adults live with high blood pressure, a condition frequently enough lacking obvious symptoms yet significantly elevating the risk of severe health issues like heart attack, stroke, and heart failure. While long considered a condition of aging, a growing number of Americans aged 35-64 are now facing heart disease linked to hypertension, prompting renewed focus on prevention and management. Experts emphasize that controlling blood pressure is not only vital for cardiovascular health, but emerging research suggests a link to cognitive function as well. This report details the latest understanding of hypertension, from recognizing risk factors to implementing lifestyle changes and medical interventions.
Nearly half of all adults in the United States live with high blood pressure, a condition often called a “silent killer” because it frequently has no noticeable symptoms, yet significantly increases the risk of heart attack, stroke, and heart failure. Recognizing and managing hypertension is crucial for maintaining cardiovascular health and overall well-being.
While historically considered a condition primarily affecting older adults, recent research indicates a growing number of individuals between the ages of 35 and 64 are dying from heart disease related to high blood pressure.
“Hypertension is foundational because it’s the most modifiable risk factor for cardiovascular disease and stroke, and now, evidence suggests, potentially for cognitive decline as well,” said Dr. Eduardo Sánchez, chief medical officer for prevention at the American Heart Association. Lifestyle changes and medication can effectively lower blood pressure, “drastically changing the trajectory” when it comes to heart attacks and strokes, he added.
Even small adjustments to daily routines can contribute to better blood pressure control.
Know Your Numbers
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Understanding your blood pressure is a vital first step, though estimates suggest more than half of those with uncontrolled hypertension are unaware they have it.
Blood pressure, the force of blood pushing against artery walls, is measured in millimeters of mercury (mmHg) and expressed as two numbers. The top number, systolic pressure, reflects the force when the heart beats. The bottom number, diastolic pressure, measures the force between beats, when the heart rests.
Normal blood pressure is less than 120/80 mmHg. Above this level, Dr. Sánchez explained, damage begins to occur to blood vessels and the organs they supply, including the kidneys, heart, and brain.
Regular blood pressure checks – at least annually – are important, according to Dr. Jennifer Cluett, director of the Complex Hypertension Clinic at Beth Israel Deaconess Medical Center in Boston. Proper measurement technique is also key: use a correctly sized cuff, sit with both feet flat on the floor, keep your arm at heart level, and avoid talking during the reading.
“The typical busy primary care clinic setting – where someone is sitting on an exam table with legs dangling and their arm unsupported while someone is talking to them – is not ideal,” Dr. Cluett said.
Up to 30% of patients may experience “white coat hypertension,” where blood pressure rises in a medical setting. Because of this, current guidelines recommend home monitoring to confirm a diagnosis and track the condition.
Understand Your Personal Risk
High blood pressure can stem from a variety of causes, explained Dr. Fátima Coronado, deputy scientific director of the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention. It develops over time due to a combination of genetic predisposition and environmental factors, such as smoking, being overweight, and insufficient sleep.
A family history of heart attack or stroke may indicate a higher genetic risk for developing high blood pressure, Dr. Coronado noted.
Age also plays a role, as arteries naturally become stiffer with time. Hypertension is also more prevalent among Black individuals and men compared to White individuals and women.
Some women develop hypertension during pregnancy, a condition that can be dangerous for both mother and baby. Dr. Martha Gulati, director of the Davis Heart Center for Women at Houston Methodist Hospital, emphasized that this condition requires treatment during pregnancy and ongoing cardiac follow-up afterward, as it increases the risk of future hypertension and cardiovascular disease.
Follow a Heart-Healthy Diet
Prioritizing a healthy diet is a cornerstone of heart health. Specifically, the DASH (Dietary Approaches to Stop Hypertension) diet was found to be the most effective of 22 lifestyle changes and stress-reduction techniques for lowering blood pressure, according to an analysis of over 100 studies.
This effectiveness may be linked to the diet’s emphasis on potassium-rich foods, an electrolyte that helps the body eliminate sodium and relax artery walls. Sodium causes the body to retain water, increasing fluid volume and pressure within blood vessels.
Bananas aren’t the only easy source of potassium; an avocado or a cup of cubed cantaloupe contains even more, and citrus fruits like oranges and leafy green vegetables like spinach and chard are also rich in this electrolyte.
Further lowering blood pressure can be achieved by reducing sodium intake alongside the DASH diet, Dr. Gulati said. The American Heart Association recommends limiting sodium consumption to a maximum of 2300 milligrams per day, and ideally, much less. In the U.S., most dietary sodium comes from restaurant meals and processed foods.
Reducing these foods – swapping a frozen dinner or slice of pizza for a salad bar, for example – or making small changes during grocery shopping can make a significant difference. Look for low-sodium versions of sauces. Rinse canned beans and vegetables, which are often stored in salty water, before consuming.
Alcohol consumption is also linked to increased blood pressure. Doctors suggest abstinence. The benefits of reducing intake appear greatest for those who consume more than two drinks per day.
Move Your Body and Manage Stress
Aerobic exercise, which strengthens the heart so it can pump more efficiently, was the second most effective intervention after the DASH diet. Isometric resistance exercise (contracting muscles and holding a position, like a wall sit or plank) was the third. Isometric exercise can help dilate blood vessels, improving blood flow.
Exercise also helps reduce stress, as do meditation and yoga. Other forms of prayer and religious practice can also be stress-reducing, Dr. Sánchez said.
And while exercise is beneficial even without weight loss, Dr. Cluett added, losing excess weight can also lower blood pressure.
Don’t Fear Medication
The goal of treatment is to keep blood pressure below 130/80 mmHg, and even lower – below 120/80 mmHg – is even better. Often, this requires medication. Several generic and effective options are available for doctors to prescribe.
Patients may need to take multiple types of medications, which doctors acknowledge can sometimes be a deterrent. Combination pills containing two or more blood pressure medications simplify administration. While some medications can cause side effects like frequent urination or leg swelling, doctors can adjust medication regimens to mitigate these effects.
Even while taking medication, dietary and exercise changes can help and reduce the likelihood of various health problems. “Lifestyle changes help with more than just controlling your blood pressure,” Dr. Cluett said.
