Why does every visit to a doctor’s office include a blood pressure check? Because high blood pressure can wreck your life or even kill you.

Dr. Linda Calhoun

Novant Health cardiologist Dr. Linda Calhoun of Novant Health Heart & Vascular Institute - Whiteville and Shannon Emmanuel, vice president of community impact for the American Heart Association (AHA), recently held a news briefing to discuss high blood pressure, also known as hypertension.

It’s an urgent topic because hypertension is incredibly common. One-third of all Americans have the condition, and fully half of them aren’t aware they have it, said Calhoun. Here are highlights from the discussion.

Defining the issue

Simply put, having high blood pressure means your blood is pumping through your arteries with more force than is normal. That’s risky because your heart has to work overtime to pump blood at that higher rate. The added stress on your heart could lead to several life-threatening conditions.

Good health starts with a visit to your primary care physician.

Start here

In 2017, the American College of Cardiology and the American Heart Association published new guidelines for managing high blood pressure and defined stage 1 hypertension as a blood pressure at or above 130/80. Stage 2 hypertension is blood pressure at 140/90 or higher.

Blood pressure is measured by two numbers, as outlined by the Centers for Disease Control and Prevention (CDC):

  • The first number, systolic blood pressure, represents the pressure in your arteries when your heart beats.
  • The second, diastolic blood pressure, measures the pressure in your arteries when your heart is at rest between beats.

A measurement of 120 systolic and 70 diastolic (considered normal) is referred to as “120 over 70” and written as “120/70 mmHg.”

Risk factors

“Some risk factors for high blood pressure, such as family history and race, are obviously beyond our control,” Calhoun said. “Others, like diet and exercise, are within your control. Getting adequate physical activity and good nutrition can help lower your risk.”

People of color are more likely to have hypertension. Half of all Black adults have high blood pressure. Other risk factors include:

  • Sedentary lifestyle.
  • Obesity.
  • Excessive caffeine.
  • High-salt diet.
  • Excessive alcohol use.
  • Tobacco use or vaping.
  • Drug use.
  • Being overly stressed; having anxiety or depression.
  • Taking certain over-the-counter medications, including some cold and pain medicines.

You don’t have to be skydiving or getting ready to speak to a crowd to have elevated blood pressure. “Your blood pressure can spike just by going out into the world,” Calhoun said.

It can also be elevated just by walking into a doctor’s office – a phenomenon known as “white-coat hypertension.” If a first blood pressure reading is unusually high, the clinician will usually suggest you relax for a while before getting a second reading.

Why so dangerous?

“The silent killer” is an apt synonym for hypertension. An estimated 10 million people worldwide are killed each year due to health conditions that stem from it.

It can damage your heart and kidneys, lead to a stroke or aneurysm, cause vision problems, contribute to memory loss and dementia, and lead to atherosclerosis, the condition of arteries being clogged with fatty deposits.

How do you know?

Hypertension is sneaky. It’s often present without any symptoms. The only way to know if you have it is by measuring your blood pressure.

A few people with hypertension may have headaches, shortness of breath, lightheadedness and/or nosebleeds, but those don’t typically appear until the condition has reached a severe stage.

Pregnant women at risk

Pregnant women are more likely to develop hypertension. It’s common in postpartum women, as well.

Hypertension screening for pregnant women is an essential part of prenatal care. Severe or uncontrolled hypertension during pregnancy can lead to complications for mom and unborn baby, including preterm labor.

A serious condition called preeclampsia can happen during pregnancy. It’s “high blood pressure and signs of liver or kidney damage that occur in women after the 20th week of pregnancy,” according to the National Institutes of Health (NIH). While it is rare, preeclampsia may occur in a woman after delivering her baby, most often within 48 hours.

Preeclampsia is also stealthy. Subtle symptoms can include swelling of the hands and face or areas around the eyes, and sudden weight gain over a day or two, or more than 2 pounds a week.

Testing for preeclampsia includes a physical exam as well as blood and urine tests. “Preeclampsia usually resolves within six weeks after the baby is born and the placenta is delivered,” the NIH states. “However, it may persist longer or even begin after delivery.”

Combating the enemy

The American Heart Association (AHA) is one of your best resources for information and support. Local AHA chapters hold frequent community-based screenings.

“The American Heart Association brings the opportunity for people to self-manage blood pressure wherever they are, which can include churches and barbershops,” Emmanuel said. (Novant Health, too, offers healthcare screenings at barbershops.) “When able, we provide these locations equipment to allow for additional access points for residents to measure their blood pressure and with this, we ensure they are provided a referral to care as needed."

Treating high blood pressure

Proper treatment and management of hypertension could save 76 million lives by 2050.

The first line of defense: lifestyle modifications. Doctors usually ask patients to try those first. If they fail to adequately work, several categories of drugs can be effective against hypertension. They include:

  • ACE (angiotensin-converting enzyme) inhibitors, which limit the narrowing of your blood vessels.
  • ARBs (angiotensin II receptor blockers), which also keep blood vessels from narrowing.
  • Calcium channel blockers, which allow blood vessels to relax.
  • Diuretics, which remove extra water and salt from your body, reducing the amount of fluid in your blood.
  • Beta blockers, which help your heart beat slower and with less force.

What can you do?

Eat healthfully. Exercise. Don’t smoke, and don’t drink too much alcohol. Manage your stress. Maintain a healthy weight and sleep schedule.

Have your blood pressure checked at least every two years starting at age 18. Some people – like those with a family history of hypertension – need more frequent checks.

When you’re at your primary care team’s office, ask about your blood pressure reading. If it’s elevated, ask what steps you can take to lower it naturally.

Calhoun will typically give a patient three months to try to get it down on their own before she’ll discuss medication. Diuretics, beta blockers and calcium channel blockers are among classes of drugs used to control hypertension.