High Blood Pressure: Why You Can't Ignore This Silent Killer | Rounds With Dr. E

About one in five people have high blood pressure and they don't even know it

High Blood Pressure: Why You Can't Ignore This Silent Killer | Rounds With Dr. E

For those of you who love murder mysteries, there just may be a silent killer wreaking havoc inside of you. Untreated hypertension, or high blood pressure, can go undetected for a long period of time, mainly because most people with elevated blood pressure do not experience any symptoms. In fact, about one in five people with high blood pressure are walking around unaware that they even have high blood pressure. Left untreated, hypertension can place you at a significantly increased risk for heart attacks, strokes, aneurysms tearing open, heart failure, kidney failure, blockages in your legs, dementia, vision problems including blindness, and sexual dysfunction (I bet that last one got some of your attention).

How to Read Your Blood Pressure Numbers

Your blood pressure is made up of two numbers. The top number, called the systolic blood pressure, is the pressure inside your arteries when your heart contracts. The bottom number, the diastolic blood pressure, is the pressure inside your arteries when your heart relaxes. Both numbers are important and should be monitored. As people age, both numbers tend to increase, mainly due to increased stiffness in large vessels. Frighteningly, many studies have demonstrated that just a 20 mm Hg (units used for blood pressure) increase in the systolic number, or a 10 mm Hg increase in the diastolic number, doubles one's risk of death from heart disease or stroke.

What Is Considered "High" Blood Pressure

To emphasize the serious health consequences of having hypertension and to acknowledge that almost one in two adults (including one in four adults aged 20-44) are at increased health risk, the American College of Cardiology and the American Heart Association in 2017 revised what is considered high blood pressure. They defined normal blood pressure as 120/80 or lower, elevated blood pressure as 120-129/80, and hypertension as blood pressure readings of greater than 130/80 on multiple occasions. Of note, if your diastolic (bottom number) blood pressure is greater than 80, you have hypertension. Anyone with elevated blood pressure or hypertension should be encouraged to initiate lifestyle modifications, including dietary salt restriction, weight loss (losing 10 pounds may lower your blood pressure by 5 to 10 mm hg), exercise, smoking cessation, and limiting alcohol intake to no more than 1 to 2 drinks daily. Depending on your blood pressure numbers and whether you have other cardiac risk factors (such as diabetes or a family history of heart disease), your doctor will likely prescribe medication, as medical therapy has clearly been shown to improve both blood pressure and health outcomes. As there are many different medication options, many of which have very few side effects, you and your physician can decide which medication may be best for you.

Take Your Blood Pressure at Home

Should you now run out and have your blood pressure checked or perhaps splurge on a machine so you can monitor your blood pressure at home? Yes! For those of you with white coat hypertension (just seeing a doctor's white coat raises your blood pressure) who have high blood pressure readings at the doctor's office but normal ones at home, monitoring your blood pressure at home can be extremely useful. In fact, make sure to write down your blood pressure readings and show them at your next doctor's visit.

Although the majority of people with hypertension inherit it from one or both parents, your physician will likely rule out other causes, as many medications including pain medications, contraceptives, and anti-depressants can also contribute to high blood pressure. In addition, you may be evaluated for a common and treatable condition called sleep apnea in which your throat intermittently closes during sleep and accordingly induces high blood pressure.

You Can Catch the Killer

Being proactive and having your blood pressure screened may save you from the not-so-silent health consequences of having untreated hypertension, such as heart attacks and strokes. Knowing your blood pressure numbers and starting treatment if appropriate are surely the best ways for you to apprehend and arrest (I know, too much?) this silent killer among us.

By Dr. Marc Eisenberg

Dr. Marc Sabin Eisenberg, M.D., F.A.C.C. is an associate professor of medicine at Columbia University Medical Center. He is co-author of the book "Am I Dying?!: A Complete Guide to Your Symptoms and What to Do Next" and co-host of the "Am I Dying?!" podcast, which provides light-hearted advice for the hypochondriac in all of us.