Did you know that your blood pressure can be a good indicator of your heart’s health?

High blood pressure is actually a leading risk factor for heart disease and early death. It’s sometimes called the “silent killer” because many people don’t know they have it, yet it can do a lot of harm. At your next health checkup, when your health care provider puts a cuff around your arm to take your blood pressure, be sure to ask about your numbers.

If you already have high blood pressure, the good news is that even small reductions in your blood pressure can help protect your cardiovascular health, and as a result help prevent heart attacks, stroke, heart failure and chronic kidney disease.

What is Blood Pressure?

Blood pressure is a measure of how hard your blood pushes against your arteries as it moves through your body.

Blood pressure rises and falls naturally during the day. But if it stays too high, over time it can lead to health problems. High blood pressure is also called hypertension.

Why Blood Pressure Matters

Blood pressure can affect your body in many ways. Untreated, high blood pressure increases the strain on the heart and arteries, and it can eventually lead to:

• blood vessel damage (atherosclerosis)
• heart attack
• stroke
• heart failure
• kidney failure
• eye damage

Often, there may be no signs or symptoms that tell you when your blood pressure is too high. Not surprisingly, the higher it is, the more likely you are to have these problems. The good news: High blood pressure can be treated or even prevented.

What Do Your Numbers Mean

Blood pressure is given as two numbers. You’ve probably heard your health care provider say something like “130 over 80.” So what do these numbers mean?

• Systolic, the top number, is the pressure or force in the arteries when the heart pumps. When the heart contracts, the pressure in the arteries rises.
• Diastolic, the bottom number, is the pressure in the vessels when the heart relaxes between heartbeats.

These numbers are measured in millimeters of mercury (mmHg). According to new ACC/AHA High Blood Pressure Guidelines released in November 2017, high blood pressure is now defined as a systolic blood pressure (higher number) of 130 mmHg or above or a diastolic blood pressure (lower number) of 80 mmHg or above, or both. You can have high blood pressure even if just one of the numbers is above what it should be.

If you have a systolic blood pressure from 120-129 mmHg, and your diastolic blood pressure is less than 80 mmHg, then your blood pressure is elevated.

Blood Pressure Classifications

Even if your blood pressure is only slightly elevated, you need to take it seriously. Blood pressure measures that are close to the cutoff for having hypertension can serve as a red flag that it’s time to step up efforts to prevent high blood pressure.

Talk with your health care team about learning how to check and track your blood pressure over time.

What are the signs and symptoms of high blood pressure? Usually none. That’s why many people don’t realize they have high blood pressure.

High blood pressure is often found during a routine office visit when your health care professional checks it along with other vital signs.

In some cases, people with more severe high blood pressure may have:

• Severe headaches
• Vision changes
• Nausea/vomiting
• Nosebleeds
• Confusion

Some things can make high blood pressure more likely. For example:

• Being older or getting older (as we age, blood vessels get stiffer)
• Being very overweight
• Drinking too much alcohol
• Having a family history of high blood pressure
• Eating too much salt
• Having diabetes
• Smoking

In addition, African-Americans are more prone to having high blood pressure. Prolonged stress also can increase your blood pressure. And, in some cases, having low levels of potassium in your diet make it more likely for you to have the condition.

Other health conditions such as sleep apnea, chronic kidney disease and high blood pressure during pregnancy (preeclampsia) can trigger high blood pressure. Certain medications can also cause your blood pressure to rise, for example some diet pills and cold medicines.

If you have high blood pressure, your health care professional will consider and rule out possible causes. It’s an important step because understanding the cause will help guide how you manage your blood pressure.

How does my health care professional know for sure that I have high blood pressure? If your blood pressure seems high, your health care professional may measure your blood pressure a few times or ask that you take and record your blood pressure at home. Having multiple readings often helps to confirm you have high blood pressure.

During your office visit, your health care professional will take your health history and perform a physical exam. Make sure to share information about your risk for heart disease and any other conditions you have that might affect your blood pressure.

Your health professional may also order an ECG or other laboratory tests. Additional tests can include: urinalysis, serum potassium, blood glucose or creatinine to measure or calculate kidney function.

Can high blood pressure be prevented? Yes, you can often keep blood pressure low through healthy life choices. Some examples of healthy choices include:

• Focus on healthy eating including fresh fruits and vegetables (often rich in potassium and helpful in lowering your blood pressure naturally), lean protein and low-fat dairy. If you are worried about your blood pressure, ask about the Dietary Approaches to Stop Hypertension (DASH) diet.
• Cut your sodium intake by lowering how much salt you eat.
• Limit how much alcohol you drink.
• Lose weight, if needed, and keep a healthy body weight.
• Get regular physical activity.
• Don’t smoke.
• Find stress-busting activities. For example, yoga and meditation have been shown to help lower blood pressure.

Your health care professional may talk with you about setting a “target goal.” Based on new guidelines released in November 2017, normal blood pressure has been lowered to less than 120/80 mmHg.

Research shows that lower blood pressure goals improve heart health. For individuals who are at high risk because of a previous heart attack or stroke, chronic kidney disease, diabetes, or because of a high ASCVD risk score, lower blood pressure measures are better.

These targets are now lower because research has shown that people with elevated or stage 1 high blood pressure—previously called “prehypertension”—are already at a higher risk of having a heart attack or stroke.

Lifestyle changes are the main treatment for those with elevated or stage 1 high blood pressure. They are also important in treating individuals with stage 2 high blood pressure (>140 mmHG/>90 mmHG) and for good health overall. Healthy choices can go a long way in helping to lower your numbers and include:

• Getting regular physical activity
• Maintaining a healthy body weight
• Focusing on healthy eating (follow the Dietary Approaches to Stop Hypertension diet, limit salt and eat potassium-rich foods)
• Limiting alcohol (no more than one drink per day for women, two drinks per day for men)
• Smoking cessation

It’s important to cut back on the amount of salt (sodium) you consume, particularly if you are already eating a diet that is high in salt. The latest Dietary Guidelines for Americans recommend people consume no more than 2,300 mg of sodium per day—less than a teaspoon of salt. However, for people with high blood pressure or at risk for it, less than 1,500 mg of sodium per day is often the goal.

Some people also will need one or more medications to help lower their blood pressure. For example:

• People with stage 1 high blood pressure who are likely to develop cardiovascular disease (those with an ASCVD risk score of 10% or higher, a formal calculation of the likelihood you will have a heart attack or stroke in the next 10 years) or other known risk factors (for example, chronic kidney disease or diabetes).
• People with stage 2 high blood pressure.

Some common medications used in treating high blood pressure include thiazide-type diuretics, calcium channel blockers, ACE inhibitors, aldosterone antagonists and beta blockers, which may be considered specifically if the person has coronary artery disease after heart attack or heart failure. You may need multiple medications, especially if your numbers are significantly above your goal.

It’s important to take medications exactly as prescribed and report any side effects. Be sure to share a complete list of all the medications you take, including over-the-counter drugs and supplements.

The new guidelines lower the threshold for when treatment is needed. If you’re already being treated for high blood pressure, it’s a good time to review your treatment plan and decide with your care team whether your target blood pressure numbers should be lower. You might need to step up your lifestyle changes or medication, or both.

Tracking your blood pressure is a key part of managing it. Find out how often you should take and keep a record of your blood pressure readings. Having this information in hand can help your health care professional know what is working and when to adjust your treatment plan.

Other conditions, sometimes called secondary causes, might be triggering high blood pressure and should be taken into consideration. These conditions include sleep apnea, chronic kidney disease, certain medications, and adrenal or thyroid disorders.

If you’ve been diagnosed with high blood pressure, there are several key questions that you should ask your cardiologist during your next visit. These questions will ensure that you and your doctor have discussed your major risk factors so that you can become or stay as healthy as possible.

• What is high blood pressure, and what causes it?
• How do I correctly check my blood pressure at home? How often should I check it?
• I haven’t really been concerned about my blood pressure. It’s always been below 140/90 mm Hg. What’s different now?
• What is the best blood pressure for me?
• What are the consequences of not controlling my blood pressure?
• How does my risk of heart disease factor into my blood pressure treatment?
• What medicines do I need to take and for how long?
• What does untreated high blood pressure do to my body?
• Is it better to take more of one medicine or multiple medicines?
• Will I need blood work after starting some of these medicines? What are we looking for on the blood work?
• What can I do to keep my sodium intake to under 1,500 mg? What types of foods lower blood pressure?
• How does being overweight affect my blood pressure. What type of diet should I begin to lose weight?
• What type of exercise is best to lower my blood pressure?
• How does stress affect my blood pressure, and what can I do to lower my stress levels?
• High blood pressure is a risk factor for coronary disease. Have I been screened for coronary disease?