Because it draws zero attention to itself, high blood pressure — the technical term is hypertension — seems to be the easiest to shrug off of all ongoing health conditions in American adults.
It’s symptomless. It’s sneaky. A trivial paper cut will cause you more pain and suffering than this important aspect of your health.
Nearly half of all American adults have high blood pressure, according to the American Heart Association, and many don’t even know it.
But hypertension doesn’t stay symptomless forever, according to Dr. Noreen Nazir, a preventive cardiologist at Oregon Health & Science University.
“In the early stages, you can have elevated numbers but no sustained symptoms,” Nazir said. “The body is trying to compensate. It can do this for a time but you may be on your way to developing symptoms and developing negative outcomes later on.”
According to the American Heart Association, chronic hypertension — that is, blood pressure that stays too high for too long — increases one’s risk of heart attack, stroke and a host of other health problems, from heart and kidney disease to vision loss and sexual dysfunction.
“Most people experience very little symptoms until it’s too late,” said Dr. Richard Segal, an internal medicine specialist at Kaiser Permanente in Salem, Ore.
Heart disease is the No. 1 cause of death for adults in the United States, according to the Centers for Disease Control and Prevention. Stroke is No. 5.
“Worldwide, raised blood pressure is estimated to cause 7.5 million deaths, about 12.8 percent of the total of all deaths,” according to the World Health Organization.
That’s why it’s important to get screened, understand what your numbers mean and come up with a plan if you need one.
“If you have risk factors you want to mitigate them,” Nazir said. “And if you have hypertension, you want to get it under control. You don’t want it to get worse.”
Physics vs. fast food
High blood pressure is really a simple physics problem, Nazir said. It happens when too much fluid is forced through constricted blood vessels.
Age and genetics are two reasons why healthy blood vessels may constrict over time, but our own behavior is usually the bigger factor. Smoking, an unhealthy diet, more than a little alcohol and lack of exercise are chief culprits. They all contribute to constricted, stiffened blood vessels as well as the buildup of plaque, which further blocks the way.
“Smoking is the No. 1 thing,” Segal said. “The nicotine in tobacco is a major factor in narrowing the blood vessels and letting plaque build up.”
Sugar, fat and alcohol are also culprits, Nazir said. Sodium is the most infamous blood-pressure raiser of all.
“Salt is everywhere,” she said. “It is easy to overdo and it has a lot of impact, as it causes the body to retain more fluid and the heart to pump more fluid.”
Industrial and commercial foods have everything to do with this, according to the CDC, which notes that sodium in restaurant and processed foods “contributes to high rates of blood pressure, heart attack and stroke.”
Still, Kaiser’s Segal cautioned against freaking out about hidden salt. If you take the trouble to read labels, make smart food choices and stay out of the drive-thru lane, he said, your sodium intake shouldn’t be much of a problem.
“And could you please make that with no salt or as little salt as possible?” is the way to make a polite nuisance of yourself in restaurants. Why not? You are paying for your food. Your hypertensive dining companions likely will admire your gumption, and even follow your lead.
Exercise is the best prescription for, well, just about everything, Segal said.
In terms of blood pressure, aerobic exercise strengthens the heart muscle as well as the elasticity of blood vessels. While it causes a temporary spike in blood pressure, exercise also promotes a healthier, more efficient, more resilient cardiovascular system overall.
Even obese people can benefit in myriad ways from getting moving, Segal said. In addition to a direct effect on blood pressure, moderate exercise promotes weight loss, stronger muscles and better moods.
And that’s important, Nazir said, because chronic stress is another blood pressure booster.
Walking, jogging, hiking, swimming and dancing are all great examples of aerobic exercise. The American Heart Association recommends that we all try for at least 30 minutes of moderate exercise, five days per week. If that’s new to you, start slowly and build toward it. If 30 minutes at once is too much, break it into 15- or 10-minute chunks.
(If you already have heart issues or have had a heart attack, check with your doctor first.)
Unhealthy habits aren’t the only reason why nearly half of all Americans have high blood pressure. The definition of “high” has also changed.
“We recognize, medically, that it’s healthier to have lower blood pressure,” Segal said. “We are watching our guidelines continuously drop.”
In 2017, the marker for detecting, managing and treating hypertension was lowered from 140/90 to 130/80. That swept many millions more people into a newly expanded group that ought to be testing and managing their blood pressure.
The new guideline stemmed from numerous clinical studies that showed that achieving lowered blood pressure goals significantly reduced the rate of “heart events” and death, according to the American Heart Association.
But because doctor’s offices tend to give people the willies and cause what’s known as White Coat Syndrome (anxiety that produces high blood-pressure readings), testing yourself in the comfort of your home will give you more meaningful results, Segal said.
Today’s over-the-counter arm cuffs are reliable and affordable, Segal said. He doesn’t recommend finger or watch-style wrist blood pressure readers, which are not accurate enough, he said.
When to test? Other than waiting half an hour or more after coffee — that’s a guaranteed spike — there’s no wrong answer.
“I always say the best time is whenever you can,” Nazir said.
Many people check right after waking in the morning but before eating or drinking anything. Then they become dismayed to discover that, despite still feeling groggy, their blood pressure is surprisingly high.
That’s thanks to your body’s natural release of the stress hormone cortisol, which helps you rev up in the morning and typically drives a blood-pressure spike, Nazir said.
Be aware of that dynamic, Segal and Nazir both said, but don’t let it alarm you. Test at various times during the day and you’ll likely be surprised at how much blood pressure varies. At night, when your day is winding down, you might just be surprised and comforted to see how low it goes.
More information is always better, Nazir said. Whenever you test, do it three times. Your digital reader can probably calculate the average for you.
“The important thing is the average,” Segal said.