Hypertension is often referred to as the silent killer. That’s because you can have high blood pressure for a long time but have few to no symptoms. In the meantime, hypertension can cause serious health problems.
Leigh Simmons, MD, a Mass General Brigham general internist, answers common questions about hypertension, its signs and symptoms, the risks of high blood pressure, and how to lower it.
High blood pressure and hypertension are similar, related conditions, but they’re not the same:
High blood pressure is a measurement of an elevated blood pressure in the body’s arteries. If you have a high blood pressure reading, your health care provider checks to see if the high blood pressure is temporary, or if it is a chronic condition.
Hypertension is when you have chronically high blood pressure. If you have hypertension, you need treatment and monitoring.
Blood pressure measures the force of blood pushing against the walls of your arteries, which bring blood from your heart to the rest of your body. It’s measured in two numbers:
Systolic: The pressure when your heart beats, or contracts
Diastolic: The pressure when your heart rests between beats
Dr. Simmons explains, "Systolic is the top number when you write it out, and the diastolic is the bottom number when it's written out. Both numbers are important to monitor and to keep in good control.”
According to the American Heart Association, normal blood pressure is 120/80 mmHg, or 120 systolic over 80 diastolic. The unit used to measure blood pressure is millimeters of mercury or mmHg.
Most people should aim to keep their blood pressure less than 130 for the top number and less than 85 for the bottom number. However, depending on your overall health and your health conditions, your target blood pressure might be lower or higher than those numbers.
Most people with hypertension don't have any obvious symptoms of the condition. However, some symptoms of dangerously high blood pressure can let you know something is wrong. These include:
Shortness of breath
If you have any of these symptoms, call your primary care provider (PCP) or visit the closest emergency room as soon as possible.
Chronic high blood pressure can thicken the walls of your arteries. This makes it hard for blood to get to your smallest vessels, down to your legs and toes, into your kidneys and other internal organs, up to your head and then to your brain. We need blood flow to those parts of the body in order to function well and to stay alive.
Hypertension can also lead to:
There are several changes you can make in your daily habits to lower your blood pressure and hypertension risk. Adding regular physical activity gets your heart rate up.
"If you can exercise for at least 150 minutes a week, it can make a big difference in lowering your blood pressure," says Dr. Simmons. “You can divide up those minutes into small chunks of exercise. Just make sure you are staying active regularly with an activity you enjoy doing, so you will want to do it more often.”
Reducing the amount of salt you eat every day can also make a difference. Avoid adding extra salt to your food. Cut back on processed foods and don’t eat out too often. Reducing or eliminating alcohol also can lead to healthier blood pressure.
If lifestyle changes don’t lower your blood pressure to healthier numbers, your provider may recommend medication. Most patients need to keep taking two or more medications to reduce their blood pressure to the target range; some patients need to take more.
Often, the combination of medicines and lifestyle changes can bring you to your goal blood pressure. "I've had patients who started a walking or a running program and over time were able to stop their pills because the regular exercise was controlling their blood pressure,” says Dr. Simmons. “Other patients have stopped alcohol and they found that their blood pressure came down to a level that they didn't need to take any more pills."
Talk to your doctor before reducing or stopping your blood pressure medications. Some medications, if stopped too suddenly, can raise your blood pressure to dangerous levels. Your doctor can help you come up with a plan to taper down safely.
“Hypertension can affect anyone,” says Dr. Simmons. “The number-one risk factor for whether you will develop hypertension is your family history of hypertension or high blood pressure.”
If hypertension runs in your family, particularly in your parents or siblings, tell your doctor. They can develop a monitoring plan with you, and help you work on measures to reduce the risk of developing hypertension yourself. If you are diagnosed with hypertension, know that it is common, manageable, and highly treatable.