By age 40, more than half of Americans have high blood pressure, but many are unaware of it. Hypertension has long been known as the silent killer. When it’s left untreated, it can be deadly. And it’s considered a silent threat since most people have no symptoms. You can’t feel the pressure in your blood vessels increasing.
New recommendations from the American Heart Association aim for early treatment, including lifestyle changes and medications, once systolic blood pressure rises above 130/80 mm Hg, which stands for millimeters of mercury, a measure of pressure. Experts say it’s clear that the sooner you take action, the more you can protect yourself.
Hypertension is a leading cause of heart disease, which is the No. 1 cause of death of both men and women in the U.S. High blood pressure also increases the risk of kidney disease and dementia. And research shows that hypertension can lead to damage in small blood vessels in the brain, which is linked to cognitive decline.
“There’s a really enormous preventive health opportunity in treating hypertension earlier,” says Dr. Jordana Cohen, a nephrologist and hypertension specialist at the University of Pennsylvania. She says millions of adults in the U.S. could benefit from medications and lifestyle changes.
“If you catch it early, and treat it early, you can end up with many more years of healthy life expectancy,” Cohen says, pointing to a reduced risk of heart attacks, strokes, kidney damage, and dementia.
The new guidelines point to decades-old advice about the benefits of a low-sodium diet, which can be challenging to follow, given that more than half the calories consumed in the U.S. come from ultra-processed foods, which tend to be high in salt.
The new guidelines also emphasize lifestyle strategies, including exercise, limiting alcohol consumption, and stress reduction in the form of meditation, yoga, or deep breathing. For people with systolic blood pressure (the upper number) in the 130s, the recommendation is to start with these diet and lifestyle-related changes, then move to medication if blood pressure doesn’t improve.
How is High Blood Treated?
Prevention is one thing, but for those who have hypertension, they need to know that it can be well-managed with medication. For people who hit the risky range of a systolic blood pressure of 140 or higher, which is considered Stage 2 hypertension, evidence shows that starting on high blood pressure medications is beneficial.
“For all people with a blood pressure over 140/90 mm Hg, we recommend beginning with two medications,” Dr. Dan Jones, chair of the guideline writing committee at the Heart Association, told NPR. Research shows one medication alone is often not enough to lower blood pressure to the optimal range, he says.
Jones says even when people are aware they have hypertension, more than half don’t manage to lower it to the normal range, which is 120/80 mm Hg or lower. Some of the challenges include side effects of the medications and individual differences in how well the medication works, as well as an unwillingness to take medicines among some people. In addition, some people struggle with the everyday hurdles of making lifestyle changes. Jones points out that health care providers also use a risk calculator to estimate a person’s individual risk of heart disease as part of a treatment plan.
