High blood pressure is happening to people younger and younger.
Scott Rogge, MDYou’ve probably heard the saying, “My blood pressure went through the roof."
When you’re stressed, you might feel your heart race, your face turn hot, and your mouth go dry. But that’s a rush of adrenaline, not symptoms of high blood pressure. When your blood pressure is high, you probably don’t feel anything at all.
“That’s why we call high blood pressure the silent killer,” says cardiologist Scott W. Rogge, MD, of Southwestern Vermont Medical Center, a member of Dartmouth Health. “You can have no symptoms at all.”
Nearly half of U.S. adults have high blood pressure, also called hypertension, according to the U.S. Centers for Disease Control and Prevention.
Here’s how doctors say you can understand and manage your blood pressure.
What are the risk factors?
Obesity, diabetes, aging, sleep apnea, alcohol, tobacco use, genetics, a diet high in salt, and a sedentary lifestyle can put you at risk for high blood pressure.
“High blood pressure can be caused by multiple factors,” says cardiologist James T. DeVries of Dartmouth Hitchcock Medical Center. “We can’t change our genetic programming, but we can alter what we eat and how much alcohol we drink, our exercise routines, and our weight.”
High blood pressure can damage arteries throughout the body and can make arteries burst or clog easily.
People with hypertension in mid-life are five times more likely to have impaired cognitive function and twice as likely to experience reduced executive function, dementia, and Alzheimer’s disease, according to the American Heart Association.
Untreated high blood pressure is also a major risk factor for heart attack, stroke, and other cardiovascular diseases.
“It can cause kidney dysfunction, damage to the micro blood vessels affecting vision, and lead to significant quality of life limitations in the long run,” DeVries says.
What do blood pressure numbers mean?
Your blood pressure is measured using two numbers that represent the force of blood pushing against your blood vessel walls as your heart cycles. It’s written as a fraction, such as 120/80.
The top number, called the systolic blood pressure, measures the pressure in your arteries when your heart beats and contracts to push blood out to the body.
The bottom number, known as the diastolic blood pressure, measures the pressure in your arteries when your heart relaxes and rests between beats.
Together, these numbers determine the ranges between normal and high blood pressure:
Normal: Less than 120 systolic and less than 80 diastolic
Elevated: 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
Subscribe to the Living Better newsletter
Your trusted resource for reliable and up-to-date health and wellness information in the Northeast. Get it delivered to your inbox every other week.
Are there symptoms?
“You can be completely asymptomatic,” Rogge says.
The only time high blood pressure reliably shows noticeable symptoms is during a hypertensive crisis. That’s when your blood pressure spikes above 180/120 mm Hg (millimeters of mercury) and requires immediate medical attention. Those symptoms can include:
- Severe, sudden headaches
- Chest pain or shortness of breath
- Blurred vision or eye pain
- Dizziness, confusion, or heart palpitations
Does high blood pressure affect younger people?
Research shows that an increasing number of young adults are experiencing high blood pressure compared to previous generations.
“High blood pressure is happening to people younger and younger,” Rogge says. “We see a lot of people in their 30s who are on their computers or on their phones all day. Their blood pressure is high, and they’re not exercising or eating right.”
Blood pressure screening is also recommended for children, especially with known risk factors.
“I do think it’s very reasonable for pediatrics to screen children, especially if there’s a family history of hypertension or heart disease in the family,” Rogge says.
When do you need medication?
Your doctor may encourage you to make lifestyle changes for three months before going on medication.
“Nobody wants to take pills,” Rogge says. “We typically give people a trial period to lose some weight, exercise, and eat right. A lot of times, that will help people with borderline high blood pressure get things under control and not need to take medication.”
But after a three-month period, if your blood pressure is still above 130/80 mg, then you’ll likely need medication, Rogge says.
“At that point, it merits treatment,” he says. “Because you want to try to get your blood pressure under that 130/80 range.”
Blood pressure medicines can work in several different ways. Medication can:
- Help your body to get rid of water, which decreases the amount of water and salt in your body to a healthy level
- Relax your blood vessels
- Help your heart beat with less force
- Block nerve activity that can restrict your blood vessels
Medications can include:
- Angiotensin converting enzyme (ACE) inhibitors
- Angiotensin II receptor blockers
- Beta-blockers
Research shows that a new drug, baxdrostat, can help lower blood pressure and prevent the progression of kidney disease for anyone with hard-to-treat hypertension.
Another option is renal denervation, a minimally invasive procedure that uses a catheter to disrupt the nerves to the kidneys. It prevents the transmission of nerve signals to the brain that raise blood pressure.
“For appropriate patients who have difficulty controlling high blood pressure on multiple medications, this ‘one-and-done’ procedure offers significant improvements in blood pressure without adding more medicines,” DeVries says.
Do home blood pressure monitors work?
Experts recommend using a home monitoring device if you have high blood pressure. A blood pressure monitor can help you see if your blood pressure is under control and how it responds to new medications or lifestyle changes.
The accuracy of monitors can depend, Rogge says.
“If the cuff on your monitor is too small or too big, it's going to be inaccurate,” Rogge says. “Or if you don’t have your arm at heart height or in the right position, the reading will be off.”
You might be asked to bring your home blood pressure monitor to a doctor’s appointment to make sure the results match.
Blood pressure changes over time
Your blood pressure can fluctuate throughout the day and change with age.
“Blood pressure is inherently dynamic. As we move about, the blood pressure normally increases,” DeVries says. “Recent activity, anxiety, and even things as simple as body positioning can affect blood pressure minute to minute.”
For every 10 points your blood pressure rises, your risk for cardiac events increases, Rogge says.
That’s why screening is so important.
“Screening for high blood pressure is one of the best reasons to go for your annual checkup,” he adds. “Because if you don’t, you might not know high blood pressure is even an issue for you.”
Resources + Related Stories
American Heart Association High Blood Pressure Facts
How Do You Know If You’re Having a Stroke?
How Do Stress and High Cortisol Affect Your Health?
