How to prevent hypertension?

Contents

Blood pressure

Blood pressure is the pressure of your blood on the walls of your arteries as your heart pumps it around your body. It’s a vital part of how your heart and circulation works.

Your blood pressure naturally goes up and down all the time, adjusting to your heart’s needs depending on what you are doing. High blood pressure is when your blood pressure is persistently higher than normal.

A blood pressure reading under 120/80mmHg is considered optimal. Readings over 120/80mmHg and up to 139/89mmHg are in the normal to high normal range.

Blood pressure that’s high over a long time is one of the main risk factors for heart disease. As you get older, the chances of having persistently high blood pressure increases.

It’s very important to get your blood pressure checked regularly, and if it’s persistently high it needs to be controlled. Uncontrolled high blood pressure can lead to a heart attack or stroke. It may also affect your kidneys.

The medical name for high blood pressure over a long period of time is hypertension.

Causes

The exact causes of high blood pressure are often not clear. Your blood pressure may be strongly influenced by:

  • family history
  • eating patterns, including salty foods
  • alcohol intake
  • weight
  • how much physical activity you do.

Some medicines can also raise blood pressure.

Symptoms

You can’t feel high blood pressure. There are usually no warning signs, so you can have it and not know. That’s why it’s important to get it checked.

Diagnosis

The best way to know if you have high blood pressure is to have your blood pressure checked by your doctor or health practitioner.

They will take your blood pressure using an inflatable bag (cuff) that goes around your arm. It’s joined to a device that measures the pressure. Read more on the tests page

Blood pressure can vary at different times of the day. Sometimes it can even go up just because someone is taking it, so it’s important to have an accurate measure of your blood pressure. Talk to your doctor or health practitioner about what your blood pressure level should be.

Controlling high blood pressure

If you have high blood pressure, talk to your doctor about the best way to control it.

Lifestyle changes

Your doctor may recommend that you make some healthier lifestyle choices, like changing the food you eat or getting more exercise.

Find out more about important lifestyle changes to manage your high blood pressure. Keep your heart healthy

Medicine

Many people also need medicine to control their high blood pressure. Your doctor will tell you if you need medicine, and monitor its effects. Blood pressure medicines don’t cure high blood pressure, but they help to control it. You have to keep taking the medicines regularly, often for the rest of your life. Don’t stop taking your medicine without talking to your doctor first.

If you take medicine for your blood pressure, it’s still important to have a healthy lifestyle.

Read more about medicines

Monitoring your blood pressure

Your doctor may want you to monitor your blood pressure at home, or wear a monitor over a 24-hour period, to check how it varies. Read more on the tests page.

Keep track of your blood pressure with our Blood Pressure Record Card.

Manage your heart disease risk factors

High blood pressure is a risk factor for heart disease.

Know your risk factors and how to manage them.

Information sheets

  • Blood pressure (fact sheet for Aboriginal and Torres Strait Islander peoples) (PDF)
  • Measuring your blood pressure at home (PDF)

“I go to the gym, and I never add salt. So why do I have high blood pressure?” Despite its astonishing prevalence of one in three Americans, many people struggle with the diagnosis of high blood pressure, or hypertension. It’s worth exploring why, because being an active participant in your care is crucial for optimal blood pressure control.

Certain features make any diagnosis easier to accept:

  • First, people are more likely to accept a diagnosis if they have symptoms. A person with cough and fever will believe a diagnosis of pneumonia. But someone who feels fine would not.
  • Next, people more readily accept a diagnosis if it is not serious. Most people won’t question the diagnosis of athlete’s foot, because creams can cure it. Diagnoses that carry worse prognoses are usually harder to receive.
  • Finally, people accept a diagnosis better when they understand its cause. Some diseases have clear causes: Down syndrome and older maternal age, HIV infection and contaminated needles. A smoker who learns he has lung cancer may not be shocked. But non-smokers who receive this diagnosis usually ask, “Why me?”

People diagnosed with hypertension are often baffled, and many ask, “Why me?” This doubt makes sense, in light of the principles above. Symptoms make a diagnosis more real. But unlike many other illnesses, hypertension rarely causes symptoms. In fact, it is ominously called the “silent killer.” Some people develop headaches when their blood pressure rises into dangerous territory, but in others, hypertension can go undetected until it causes a lethal heart attack. Fortunately, it is easy and painless to measure blood pressure.

When doctors deliver the diagnosis of hypertension, they package it with serious complications. These include heart attack, kidney failure, and stroke. Doctors discuss risks to motivate their patients, but sometimes end up creating fear instead. And fear can lead to denial. Is hypertension serious? Yes, if left untreated. But when blood pressure is controlled, the risks are greatly reduced. The important message is that treating hypertension can prevent severe complications and add dramatically to life expectancy.

Last, knowing the cause of disease is helpful. In reality we rarely find just one cause for anyone’s hypertension. There are almost always multiple factors at work. Some causes can’t be prevented, like genetics and age. High blood pressure often runs in families. Genetic risk is complex, probably resulting from a combination of harmful mutations in risk genes and silencing of protective genes. There is nothing we can do to change our genetics, just as we can’t stop aging. With aging comes a universal increase in systolic blood pressure (the top number) and in the risk for heart disease. On the other hand, tackling modifiable risk factors for high blood pressure, for example, losing weight and getting more exercise, often produces great benefits.

Your odds of developing high blood pressure are pretty good

To answer the question “Why me?” it helps to know the data. The Framingham Heart Study followed a subset of 1,300 participants ages 55 to 65 who did not have hypertension at baseline. Their remarkable finding: the lifetime risk of developing hypertension was 90%. So even if you haven’t developed high blood pressure by middle age, chances are nine out of ten that you will at some point. This number is most likely so high because more of us are overweight and are living longer.

So instead of being surprised if you are diagnosed with hypertension, it is actually more logical to be amazed if you never develop it. On an optimistic note, we have seen a decline in the frequency of severe hypertension. We owe this fall to better treatment. So if you learn you have high blood pressure, the most important response is to accept the diagnosis. Hypertension can’t remedy itself; your commitment is the first step toward great blood pressure control.

Watch this video for more commentary on getting a high blood pressure diagnosis:

The Importance of Good Nutrition

Why it’s important

Most people know good nutrition and physical activity can help maintain a healthy weight. But the benefits of good nutrition go beyond weight. Good nutrition can help:

  • Reduce the risk of some diseases, including heart disease, diabetes, stroke, some cancers, and osteoporosis
  • Reduce high blood pressure
  • Lower high cholesterol
  • Improve your well-being
  • Improve your ability to fight off illness
  • Improve your ability to recover from illness or injury
  • Increase your energy level

What is good nutrition?

Good nutrition means your body gets all the nutrients, vitamins, and minerals it needs to work its best. Plan your meals and snacks to include nutrient-dense foods that are also low in calories.

Tips for eating well

Eat plenty of fruit

To get the benefit of the natural fiber in fruits, you should eat fruit whole rather than as juices.

Eat plenty of vegetables

Eat a variety of colors and types of vegetables every day.

Eat plenty of whole grains

At least half of the cereals, breads, crackers, and pastas you eat should be made from whole grains.

Choose low fat or fat free milk

These provide calcium and vitamin D to help keep your bones strong.

Choose lean meats

Lean cuts of meat and poultry have less fat and fewer calories but are still good sources of protein.

Try other sources of protein

Try replacing meats and poultry with fish, beans, or tofu.

How to fix 5 common eating problems

As you age, you may lose interest in eating and cooking. Small changes can help you overcome some of the challenges to eating well.

1. Food no longer tastes good.

Try new recipes or adding different herbs and spices. Some medicines can affect your appetite or sense of taste – talk to your doctor.

2. Chewing difficulty.

Try softer foods like cooked vegetables, beans, eggs, applesauce, and canned fruit. Talk to your doctor or dentist if there is a problem with your teeth or gums.

3. Poor digestion.

Talk to your doctor or registered dietician to figure out which foods to avoid while still maintaining a balanced diet.

4. Eating alone.

Try dining out with family, friends, or neighbors. See if your local senior center hosts group meals.

5. Difficulty shopping or cooking.

Check with your local senior center for programs that can help you with shopping or preparing meals.

Learn more about good nutrition from our Health Library:

  • Nutrition and Physical Activity
  • High Blood Pressure: Nutrition Tips
  • Alzheimer’s and Other Dementias: Maintaining Good Nutrition

How Our Plans Can Help

Tufts Health Plan Medicare Preferred plans cover colorectal, prostate and breast cancer screenings which can help detect cancer before symptoms occur, when treatment can be more effective.

Annual Wellness Exam

Tufts Health Plan Medicare Preferred plans cover an Annual Wellness Exam each plan year. This is a more comprehensive doctor’s office visit designed to develop or update a personalized plan to prevent disease or disability based on your current health risk factors.

OVERVIEW

On average, the higher an individual’s salt (sodium chloride) intake, the higher an individual’s blood pressure. Nearly all Americans consume substantially more salt than they need. Decreasing salt intake is advisable to reduce the risk of elevated blood pressure. Keeping blood pressure in the normal range reduces an individual’s risk of coronary heart disease, stroke, congestive heart failure, and kidney disease. Many American adults will develop hypertension (high blood pressure) during their lifetime. Lifestyle changes can prevent or delay the onset of high blood pressure and can lower elevated blood pressure. These changes include reducing salt intake, increasing potassium intake, losing excess body weight, increasing physical activity, and eating an overall healthful diet.

KEY RECOMMENDATIONS

  • Consume less than 2,300 mg (approximately 1 tsp of salt) of sodium per day.
  • Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.

Key Recommendations for Specific Population Groups

  • Individuals with hypertension, blacks, and middle-aged and older adults. Aim to consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation (4,700 mg/day) with food.

DISCUSSION

Salt is sodium chloride. Food labels list sodium rather than salt content. When reading a Nutrition Facts Panel on a food product, look for the sodium content. Foods that are low in sodium (less than 140 mg or 5 percent of the Daily Value ) are low in salt.

Common sources of sodium found in the food supply are provided in figure 4. On average, the natural salt content of food accounts for only about 10 percent of total intake, while discretionary salt use (i.e., salt added at the table or while cooking) provides another 5 to 10 percent of total intake. Approximately 75 percent is derived from salt added by manufacturers. In addition, foods served by food establishments may be high in sodium. It is important to read the food label and determine the sodium content of food, which can vary by several hundreds of milligrams in similar foods. For example, the sodium content in regular tomato soup may be 700 mg per cup in one brand and 1,100 mg per cup in another brand. Reading labels, comparing sodium contents of foods, and purchasing the lower sodium brand may be one strategy to lower total sodium intake (see table 15 for examples of these foods).

An individual’s preference for salt is not fixed. After consuming foods lower in salt for a period of time, taste for salt tends to decrease. Use of other flavorings may satisfy an individual’s taste. While salt substitutes containing potassium chloride may be useful for some individuals, they can be harmful to people with certain medical conditions. These individuals should consult a healthcare provider before trying salt substitutes.

Discretionary salt use is fairly stable, even when foods offered are lower in sodium than typical foods consumed. When consumers are offered a lower sodium product, they typically do not add table salt to compensate for the lower sodium content, even when available. Therefore, any program for reducing the salt consumption of a population should concentrate primarily on reducing the salt used during food processing and on changes in food selection (e.g., more fresh, less-processed items, less sodium-dense foods) and preparation.

Reducing salt intake is one of several ways that people may lower their blood pressure. The relationship between salt intake and blood pressure is direct and progressive without an apparent threshold. On average, the higher a person’s salt intake, the higher the blood pressure. Reducing blood pressure, ideally to the normal range, reduces the risk of stroke, heart disease, heart failure, and kidney disease.

Another dietary measure to lower blood pressure is to consume a diet rich in potassium. A potassium-rich diet also blunts the effects of salt on blood pressure, may reduce the risk of developing kidney stones, and possibly decrease bone loss with age. The recommended intake of potassium for adolescents and adults is 4,700 mg/day. Recommended intakes for potassium for children 1 to 3 years of age is 3,000 mg/day, 4 to 8 years of age is 3,800 mg/day, and 9 to 13 years of age is 4,500 mg/day. Potassium should come from food sources. Fruits and vegetables, which are rich in potassium with its bicarbonate precursors, favorably affect acid-base metabolism, which may reduce risk of kidney stones and bone loss. Potassium-rich fruits and vegetables include leafy green vegetables, fruit from vines, and root vegetables. Meat, milk, and cereal products also contain potassium, but may not have the same effect on acid-base metabolism. Dietary sources of potassium are listed in table 5 and appendix B-1.

Considerations for Specific Population Groups

Individuals With Hypertension, Blacks, and Middle-Aged and Older Adults. Some individuals tend to be more salt sensitive than others, including people with hypertension, blacks, and middle-aged and older adults. Because blacks commonly have a relatively low intake of potassium and a high prevalence of elevated blood pressure and salt sensitivity, this population subgroup may especially benefit from an increased dietary intake of potassium. Dietary potassium can lower blood pressure and blunt the effects of salt on blood pressure in some individuals. While salt substitutes containing potassium chloride may be useful for some individuals, they can be harmful to people with certain medical conditions. These individuals should consult a healthcare provider before using salt substitutes.

FIGURE 4. The relative amounts of dietary sodium in the American diet. a

a Source: Mattes RD, Donnelly D. Relative contributions of dietary sodium sources. J Am Coll Nutr. 1991 Aug;10(4):383-93.

TABLE 15. Range of Sodium Content for Selected Foods

The ranges of sodium content for selected foods available in the retail market. This table is provided to exemplify the importance of reading the food label to determine the sodium content of food, which can vary by several hundreds of milligrams in similar foods.

a All snack foods are regular flavor, salted.

Source: Agricultural Research Service Nutrient Database for Standard Reference, Release 17 and recent manufacturers label data from retail market surveys. Serving sizes were standardized to be comparable among brands within a food. Pizza and bread slices vary in size and weight across brands.

Note: None of the examples provided were labeled low-sodium products.

Fighting back against the “silent killer”

High blood pressure (HBP, or hypertension) is a symptomless “silent killer” that quietly damages blood vessels and leads to serious health problems.

While there is no cure, using medications as prescribed and making lifestyle changes can enhance your quality of life and reduce your risk of heart disease, stroke, kidney disease and more.

Know your numbers

Is your blood pressure in a healthy or an unhealthy range? The best way to know is to get your blood pressure checked.

If you’re diagnosed with high blood pressure, you should monitor your blood pressure regularly. Maintaining an awareness of your numbers can alert you to any changes and help you detect patterns. Tracking your results over time will also reveal if the changes you’ve made are working. Download a printable blood pressure log (PDF).

BLOOD PRESSURE CATEGORY SYSTOLIC mm Hg
(upper number)
DIASTOLIC mm Hg
(lower number)
NORMAL LESS THAN 120 and LESS THAN 80
ELEVATED 120 – 129 and LESS THAN 80
HIGH BLOOD PRESSURE
(HYPERTENSION) STAGE 1
130 – 139 or 80 – 89
HIGH BLOOD PRESSURE
(HYPERTENSION) STAGE 2
140 OR HIGHER or 90 OR HIGHER
HYPERTENSIVE CRISIS
(consult your doctor immediately)
HIGHER THAN 180 and/or HIGHER THAN 120

Make changes that matter:

  • Eat a well-balanced diet that’s low in salt
  • Limit alcohol
  • Enjoy regular physical activity
  • Manage stress
  • Maintain a healthy weight
  • Quit smoking
  • Take your medications properly
  • Work together with your doctor

Managing blood pressure is a lifelong commitment

If you have high blood pressure, it’s vital that you listen to your doctor. Remember: You’re a part of your healthcare team. You and your doctor are partners.

Educate yourself about HBP and learn how to monitor your blood pressure at home. Armed with this information, you can commit to living heart healthy.

By adopting a heart-healthy lifestyle, you can:

  • Reduce high blood pressure.
  • Prevent or delay the development of high blood pressure.
  • Enhance the effectiveness of blood pressure medications.
  • Lower your risk of heart attack, stroke, heart failure, kidney damage, vision loss and sexual dysfunction.

You can fight high blood pressure

While heart disease is still the No. 1 killer in the United States and around the world, death rates have decreased significantly. Earlier and better treatment of high blood pressure has played a key role in that decrease.

6 Ways to Prevent Hypertension

To avoid a hypertension diagnosis, make these healthy lifestyle choices:

  1. Maintain a healthy weight. When it comes to hypertension prevention, your weight is crucial, says Dr. Ogedegbe. People who are overweight should try to lose weight, and people of normal weight should avoid adding on any pounds. If you are carrying extra weight, losing as little as 10 pounds can help prevent high blood pressure. Talk with your doctor about the best weight for you.
  2. Eat a balanced diet. Eating healthful foods can help keep your blood pressure under control. Get plenty of fruits and vegetables, especially those rich in potassium, and limit your intake of excess calories, fat, and sugar. Consider following the Dietary Approaches to Stop Hypertension, or DASH, diet, which has been shown to help manage blood pressure.
  3. Cut back on salt. For many people, eating a low-sodium diet can help keep blood pressure normal. “The higher the sodium intake, the higher the blood pressure,” says Ogedegbe. You can cut back on your total salt intake by avoiding high-sodium packaged and processed foods and not adding extra salt to your meals. “I tell people to stay away from salt shakers,” adds Ogedegbe
  4. Exercise regularly. Get moving to prevent hypertension. “Physical activity is crucial,” says Ogedegbe. The more exercise you get, the better, but even a little bit can help control blood pressure. Moderate exercise for about 30 minutes three times a week is a good start.
  5. Limit the alcohol. Drinking too much alcohol can lead to high blood pressure. For women, that means no more than one drink a day, and for men, no more than two.
  6. Monitor your blood pressure. Make sure that you have your blood pressure measured regularly, either at your doctor’s office or at home. High blood pressure often occurs with no symptoms, so only blood pressure readings will tell you if your blood pressure is on the rise. If your doctor determines that you have prehypertension — blood pressure in the range of 120-139/80-89 millimeters of mercury (mmHg) that puts you at increased risk of developing hypertension — your doctor may recommend extra steps as a safeguard.

Take a look at your lifestyle habits and decide where you can make changes to help prevent hypertension. Conquer small goals, such as snacking on fruits and vegetables instead of junk food, and continue to practice these good habits until they are a part of your daily routine.

Adopting these lifestyle changes can help prevent high blood pressure if your blood pressure is currently under control or lead to lower blood pressure if your numbers are already elevated.

Return to the Hypertension Awareness Center.

Hypertension: Strategies to Control It

  • Aerobic: Activities include brisk walking, cycling, water aerobics, swimming and more.
  • Regular aerobic activity helps you:

    • Prevent and control high blood pressure
    • Lose weight/maintain ideal weight
    • Manage diabetes
    • Manage stress
    • Improve blood cholesterol levels
    • Have more energy

    One drink = 12 ounces of beer or wine cooler, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

    Limit your alcohol intake

    Drinking too much alcohol can raise your blood pressure and affect treatment for high blood pressure.

    Most men should not have more than two alcoholic drinks per day.

    Most women should not have more than one drink per day.

    Control stress and anger

    Your blood pressure rises when you are stressed or angry. Uncontrolled stress, over time, can lead to high blood pressure and heart disease.

    Tips to control stress and anger:

    • Manage your time
    • Set realistic goals of what you can do each day
    • Take time each day to relax
    • Learn and practice relaxation techniques

    You may find it helpful to work with a therapist to help manage stress and anger. Take all medications as prescribed

    Your doctor may prescribe medications to help you reach your blood pressure goal. There are many different types of blood pressure medications. You may need to try different medications to see which one works best for you.

    Tips when taking high blood pressure medications:

    • Carefully follow your doctor’s instructions on how and when to take your medications
    • Do not stop taking any medication without first talking to your doctor

    Follow-up with your health care team

    An important part of your plan of care is regular follow-up visits with your healthcare team. This team includes your doctors, nurses and other providers. Ask your doctor how often you need to be seen. You may have visits every one to four weeks until your blood pressure is under control.

    You may also need to keep track of your blood pressure at home by checking it one or more times a day.

    Bring a list of all the medications you take, your blood pressure record and a list of any questions you have to each visit.

    Make other recommended lifestyle changes

    • Stop using all tobacco products. Smoking and tobacco seriously increase your risk of many healthy problems, including heart and blood vessel disease. Ask your doctor about medications and tools to help you quit. Ask your family and friends for support as you quit. You may also find Cleveland Clinic’s Tobacco Treatment program helpful. Call 216.448.4325 for more information or to schedule an appointment.
    • Lower your cholesterol and triglyceride levels. Your total cholesterol should be under 200 mg/dl. Your low-density-lipoprotein (LDL/ “bad”) cholesterol level should be:
      • Under 130 mg/dl or
      • Under 70 mg/dl if you have cardiovascular disease or
      • Under 100 mg/dl if you have a very high risk of cardiovascular disease

    Your triglyceride levels should be less than 150 mg/dl. Your healthcare provider can give you information about how to lower your cholesterol levels and will tell you how often to have your levels checked.

    • Raise your high-density-lipoprotein (HDL/ “good”) cholesterol level. The ideal HDL level for men is higher than 40 mg/dl. The idea HDL level for women is higher than 50 mg/dl.
    • Follow a Mediterranean diet. Eat plenty of whole and plant-based foods. These include fruits, vegetables, whole grains and nuts. Fats should be heart-healthy (monosaturated, Omega 3). Good sources of monosaturated fats are olive oil, olives, nuts and avocados. Omega 3 fats are found in tuna, salmon, flaxseed and walnuts. Avoid foods that are high in sodium, saturated fat and cholesterol. Ask your doctor or a registered dietitian for more information about the Mediterranean diet.
    • Manage other health conditions especially if you have diabetes.

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    ACC/AHA Primary Prevention Guideline Provides Playbook For Managing CV Risk Factors

    The new ACC and American Heart Association (AHA) primary prevention guideline provides a comprehensive roadmap of strategies that can be used and tailored to help prevent or slow the development of atherosclerotic cardiovascular disease (ASCVD). The guideline, released today during ACC.19 in New Orleans, LA, also emphasizes the need to identify and address personal or social barriers (e.g., income and education levels, cost concerns, lack of health insurance, access to healthy foods or safe places to exercise, life stressors) as part of overall prevention, and sets a new tone for aspirin use, saying it should rarely be used.

    “The most important way to prevent cardiovascular disease … is by adopting heart healthy habits and to do so over one’s lifetime,” said Roger S. Blumenthal, MD, FACC, co-chair of the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. “More than 80 percent of all cardiovascular events are preventable through lifestyle changes, yet we often fall short in terms of implementing these strategies and controlling other risk factors.”

    The guideline consolidates existing recommendations and new research, expert consensus documents, and clinical practice guidelines into a single source of guidance on the primary prevention of ASCVD. It underscores healthy lifestyle changes and risk assessment as the cornerstone of preventing cardiovascular disease and goes a step further by providing practical advice based on the latest research and proven interventions for improving diet and exercise, tobacco cessation and optimally controlling other risk factors like obesity, diabetes, high cholesterol and high blood pressure.

    Some of the key lifestyle recommendations include engaging in regular exercise (at least 150 minutes of moderate-intensity activity each week); aiming for and maintaining a healthy weight; avoiding tobacco (including vaping or second-hand smoke); and eating healthier by choosing more vegetables, fruits, legumes, nuts, whole grains, and fish, while limiting trans fats, added sugars, red meats, sodium and saturated fats.

    Recommendations related to team-based care, shared decision-making, and assessment of social determinants of health are also included. “Social determinants of ASCVD risk – and their impact on the patient’s ability to prevent or treat risk factors – must be taken into account,” the authors said. “Clinicians need to consider patients’ health literacy and education levels and assess patients’ motivation to improve their lifestyle habits.”

    Other guideline highlights include a recommendation that aspirin rarely be used to help prevent heart attacks and stroke in people without known cardiovascular disease. The authors cite recent research suggesting the bleeding risks associated with aspirin may outweigh the benefits. “Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” Blumenthal said. “It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin. Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding.”

    Additionally, based on a simplified synopsis of the latest ACC/AHA Cholesterol Guideline, the new guideline suggests statins be recommended with lifestyle changes to prevent cardiovascular disease among people with elevated low density lipoprotein cholesterol levels (≥ 190 mg/dl), type 2 diabetes, and anyone who is deemed to have a high likelihood of having a stroke or heart attack upon reviewing their medical history and risk factors and having a detailed discussion with their clinician.

    However, the authors note: “Even if a blood pressure–reducing medication, lipid-lowering medication, or diabetes medication is ultimately prescribed, lifestyle goals should be emphasized on a regular basis. Only when a person’s risk is sufficiently high should medications to reduce ASCVD risk be considered as part of a shared decision-making process for optimal treatment.”

    The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease was simultaneously published in the Journal of the American College of Cardiology and Circulation.

    Visit the Primary Prevention of Cardiovascular Disease Guideline Hub on ACC.org for clinician and patient resources. The JACC Prevention Guideline Hub also has tools including the central illustration.

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    Clinical Topics: Dyslipidemia, Prevention, Homozygous Familial Hypercholesterolemia, Lipid Metabolism, Nonstatins, Diet

    Keywords: ACC19, ACC Annual Scientific Session, Tobacco, Cholesterol, LDL, Blood Pressure, Aspirin, Diabetes Mellitus, Type 2, Health Literacy, Tobacco Use Cessation, Social Determinants of Health, Hypercholesterolemia, Cholesterol, Atherosclerosis, Atherosclerosis, Diet, Stroke, Risk Assessment, Life Style, Primary Prevention, Habits, Insurance, Health, Obesity

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    The prevention and management of hypertension are major public health challenges for the United States. If the rise in BP with age could be prevented or diminished, much of hypertension, cardiovascular and renal disease, and stroke might be prevented. A number of important causal factors for hypertension have been identified, including excess body weight; excess dietary sodium intake; reduced physical activity; inadequate intake of fruits, vegetables, and potassium; and excess alcohol intake.10,32 The prevalence of these characteristics is high. At least 122 million Americans are overweight or obese.33 Mean sodium intake is approximately 4,100 mg per day for men and 2,750 mg per day for women, 75 percent of which comes from processed foods.34,35 Fewer than 20 percent of Americans engage in regular physical activity,36 and fewer than 25 percent consume five or more servings of fruits and vegetables daily.37

    Because the lifetime risk of developing hypertension is very high (figure 8), a public health strategy, which complements the hypertension treatment strategy, is warranted. To prevent BP levels from rising, primary prevention measures should be introduced to reduce or minimize these causal factors in the population, particularly in individuals with prehypertension. A population approach that decreases the BP level in the general population by even modest amounts has the potential to substantially reduce morbidity and mortality or at least delay the onset of hypertension. For example, it has been estimated that a 5 mmHg reduction of SBP in the population would result in a 14 percent overall reduction in mortality due to stroke, a 9 percent reduction in mortality due to CHD, and a 7 percent decrease in all-cause mortality (figure 15).10,38

    Figure 15

    Systolic blood pressure distributions BP, blood pressure; CHD, coronary heart disease; SBP, systolic blood pressure

    Barriers to prevention include cultural norms; insufficient attention to health education by health care practitioners; lack of reimbursement for health education services; lack of access to places to engage in physical activity; larger servings of food in restaurants; lack of availability of healthy food choices in many schools, worksites, and restaurants; lack of exercise programs in schools; large amounts of sodium added to foods by the food industry and restaurants; and the higher cost of food products that are lower in sodium and calories.10 Overcoming the barriers will require a multipronged approach directed not only to high-risk populations, but also to communities, schools, worksites, and the food industry. The recent recommendations by the American Public Health Association and the NHBPEP Coordinating Committee that the food industry, including manufacturers and restaurants, reduce sodium in the food supply by 50 percent over the next decade is the type of approach which, if implemented, would reduce BP in the population.39,40

    Community Programs

    Healthy People 2010 has identified the community as a significant partner and vital point of intervention for attaining healthy goals and outcomes.41 Partnerships with community groups such as civic, philanthropic, religious, and senior citizen organizations provide locally focused orientation to the health needs of diverse populations. The probability of success increases as interventional strategies more aptly address the diversity of racial, ethnic, cultural, linguistic, religious, and social factors in the delivery of medical services. Community service organizations can promote the prevention of hypertension by providing culturally sensitive educational messages and lifestyle support services and by establishing cardiovascular risk factor screening and referral programs. Community-based strategies and programs have been addressed in prior NHLBI publications and other documents (Facts About the DASH Eating Plan,42 Your Guide to Lowering High Blood Pressure,43 National High Blood Pressure Education Month,44 The Heart Truth: A National Awareness Campaign for Women About Heart Disease,45 Mobilizing African American Communities to Address Disparities in Cardiovascular Health: The Baltimore City Health Partnership Strategy Development Workshop Summary Report,46 NHLBI Healthy People 2010 Gateway,47 Cardiovascular Disease Enhanced Dissemination and Utilization Centers Awardees,48 Hearts N’ Parks,49 Healthbeat Radio Network,50 Salud para su Corazón 51).

    Blood Pressure Matters

    Keep Hypertension in Check

    About 1 in 3 adults in the U.S. has high blood pressure, but many don’t realize it. High blood pressure is sometimes called a “silent killer,” because it usually has no warning signs, yet it can lead to life-threatening conditions like heart attack or stroke. The good news is that high blood pressure, or hypertension, can often be prevented or treated. Early diagnosis and simple, healthy changes can keep high blood pressure from seriously damaging your health.

    Normal blood flow delivers nutrients and oxygen to all parts of your body, including important organs like your heart, brain, and kidneys. Your beating heart helps to push blood through your vast network of blood vessels, both large and small. Your blood vessels, in turn, constantly adjust. They become narrower or wider to maintain your blood pressure and keep blood flowing at a healthy rate.

    It’s normal for your blood pressure to go up and down throughout each day. Blood pressure is affected by time of day, exercise, the foods you eat, stress, and other factors. Problems can arise, though, if your blood pressure stays too high for too long.

    High blood pressure can make your heart work too hard and lose strength. The high force of blood flow can damage your blood vessels, making them weak, stiff, or narrower. Over time, hypertension can harm several important organs, including your heart, kidneys, brain, and eyes.

    “Hypertension is a leading risk factor for death and disability worldwide,” says Dr. Paul Whelton, an expert in hypertension and kidney disease at Tulane University. “High blood pressure raises the risk of having a heart attack, heart failure, stroke, or kidney disease.”

    Anyone, even children, can develop high blood pressure. But the risk for hypertension rises with age. “Once people are in their 60s, about two-thirds of the population is affected by hypertension,” Whelton says.

    Excess weight or having a family history of high blood pressure also raises your risk for hypertension.

    African Americans are especially likely to get hypertension. Compared to Caucasian or Hispanic American adults, African Americans tend to develop hypertension at a younger age and to have a higher blood pressure on average.

    Because it usually has no symptoms, the only way to know for sure that you have hypertension is to have a blood pressure test. This easy, painless test involves placing an inflated cuff with a pressure gauge around your upper arm to squeeze the blood vessels. A health care provider may then use a stethoscope to listen to your pulse as air is released from the cuff, or an automatic device may measure the pressure.

    Blood pressure is given as 2 numbers. The first number represents the pressure in your blood vessels as the heart beats (called systolic pressure). The second is the pressure as your heart relaxes and fills with blood (diastolic pressure). Experts generally agree that the safest blood pressure—or “normal” blood pressure—is 120/80 or lower, meaning systolic blood pressure is 120 or less and diastolic pressure is 80 or less.

    “Hypertension is defined as having an average blood pressure of above 140/90,” says NIH’s Dr. Lawrence Fine, who oversees research on the treatment and prevention of hypertension. Since blood pressure can vary widely from day to day, a diagnosis of hypertension is usually based on an average of 2 or more readings taken on 2 or more occasions.

    If your blood pressure falls between “normal” and “hypertension,” it’s sometimes called prehypertension. People with prehypertension are more likely to end up with high blood pressure if they don’t take steps to prevent it.

    “We know we can prevent high blood pressure through diet, weight loss, and physical activity,” Whelton says. “We can also treat it, and we can treat it effectively.”

    If you’re diagnosed with high blood pressure, your doctor will prescribe a treatment plan. You’ll likely be advised to make healthy lifestyle changes (see the Wise Choices box). You may also need to take medications. The goal of treatment is to reduce your blood pressure enough to avoid more serious problems.

    How low should you aim when reducing your blood pressure? The answer depends on many factors, which is why it’s important to work with your doctor on blood pressure goals. Most current guidelines recommend aiming for a systolic pressure below 140. These medical guidelines are sometimes adjusted as new research is reported.

    A large NIH-funded study recently found there may be benefits to aiming for a much lower systolic pressure—120 or less, instead of 140—at least for some people. The study looked at adults ages 50 and up who had increased risk for cardiovascular disease but didn’t have diabetes. Half aimed for a systolic pressure of 120. The rest aimed for a pressure of 140.

    The study was stopped early, after about 3 years, when clear benefits were seen in the lower blood pressure group. “When treating to the lower goal of 120, the risk of having a cardiovascular complication such as a heart attack or stroke was reduced by 25%, and the risk of death from all causes was reduced by 27%,” Fine says. This lower-goal group, though, tended to need 1 additional blood pressure medication; they also had more hospitalizations for side effects, including low blood pressure, fainting, and possible kidney damage.

    “Results to date suggest that for older people with hypertension and an increased risk for cardiovascular disease, it may make sense to aim for a lower blood pressure. But there may be drawbacks as well, and each patient is different,” Whelton says. “Researchers generate the evidence, so health care providers can have informed discussions with their patients about blood pressure targets.”

    NIH-funded studies have clearly shown that healthy lifestyle changes can improve your blood pressure. “Making even small changes over time can really add up,” says Kathryn McMurry, a nutrition science expert at NIH. “In terms of diet, our best advice is to follow the DASH eating plan.”

    DASH stands for Dietary Approaches to Stop Hypertension. “It’s not a diet to go on for a short period of time, but one that’s meant to be part of a healthy lifestyle and enjoyed for life,” McMurry says.

    The DASH eating plan requires no special foods. Instead, it provides daily and weekly nutritional goals. It’s high in vegetables, fruit, whole grains, and low-fat dairy foods but low in saturated fat and added sugar.

    “DASH is beneficial even for people who have normal blood pressure or who have prehypertension. It can help keep blood pressure from progressing to higher levels,” McMurry says. Learn more about DASH at www.nhlbi.nih.gov/health/health-topics/topics/dash.

    For more heart-healthy food ideas, visit healthyeating.nhlbi.nih.gov, which has nearly 200 recipes developed with input from professional chefs. “The recipes are tasty, heart healthy, and easy to make. They’re meals the whole family will enjoy,” McMurry says.

    Hypertension (High Blood Pressure)

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    What Is High Blood Pressure?

    High blood pressure, or hypertension, is when the force of the blood pushing on the blood vessel walls is too high. When someone has high blood pressure:

    • The heart has to pump harder.
    • The arteries (blood vessels that carry the blood away from the heart) are under greater strain as they carry blood.

    After a while, high blood pressure can damage the heart, brain, kidneys, and eyes. Finding and treating high blood pressure early can help people stay healthy.

    How Does Blood Pressure Work?

    Blood pressure is the force against blood vessel walls as the heart pumps blood. When the heart squeezes and pushes blood into the vessels, blood pressure goes up. It comes down when the heart relaxes.

    Blood pressure changes from minute to minute. It’s affected by activity and rest, body temperature, diet, emotions, posture, and medicines.

    What Causes High Blood Pressure?

    Most of the time, no specific cause is found. This is called essential hypertension.

    When a cause is found, high blood pressure usually is from:

    • kidney disease
    • lung problems
    • heart problems
    • obesity
    • some medicines

    While high blood pressure is most common in adults, teens can have it too. High blood pressure can run in families.

    What Are the Signs & Symptoms of High Blood Pressure?

    Most of the time high blood pressure doesn’t cause symptoms. In rare cases, severe high blood pressure can cause headaches, blurry vision, dizziness, nosebleeds, a fluttering or racing heartbeat, and nausea.

    If you have high blood pressure and any of these symptoms, get medical care right away.

    How Is Blood Pressure Measured?

    Health care providers measure blood pressure with a cuff that wraps around the upper arm. When the cuff inflates, it squeezes a large artery, stopping the blood flow for a moment. Blood pressure is measured as air is slowly let out of the cuff, which lets blood flow through the artery again.

    Blood pressure is measured in two numbers:

    1. The pressure when the heart pumps.
    2. The pressure when the heart rests between beats.

    You hear blood pressure reported as the first number “over” the second number, like 120 over 80 or 120/80.

    How Is High Blood Pressure Diagnosed?

    A single reading showing high blood pressure doesn’t mean that you have hypertension. Sometimes, blood pressure needs to be checked several times over a period of days or weeks to know if someone has hypertension. Your doctor will probably weigh and measure you. He or she might do urine tests or blood tests to check for other conditions that can cause hypertension.

    Some people have what’s called “white coat hypertension.” This means that their blood pressure goes up when they’re at a doctor’s office because they’re nervous. When they feel more relaxed, their blood pressure usually goes down. To make sure high blood pressure readings aren’t caused by anxiety, doctors will sometimes track a person’s blood pressure over a whole day. This is called ambulatory blood pressure monitoring.

    How Is High Blood Pressure Treated?

    If high blood pressure is due to a condition like kidney disease or lung disease, treating it might be enough to get the blood pressure back to normal.

    Doctors also might recommend lifestyle changes. If you have hypertension, your doctor might want you to:

    Eat a healthy diet:

    Get regular exercise:

    • Try to exercise for 30–60 minutes at least 3 times a week. But teens with severe hypertension should not do any weightlifting or power-lifting, bodybuilding, or strength training until their blood pressure is under control and a doctor says it’s OK.

    Not smoke. Or if you do smoke, quit:

    • People with high blood pressure should not smoke, and their home and car should be smoke-free.

    If diet and exercise changes do not improve the blood pressure, doctors may prescribe medicine.

    What Else Should I Know?

    It’s important to follow the advice of your care team. A healthy diet and exercise, taking medicine if needed, and getting regular blood pressure checks can help you stay healthy.

    Reviewed by: Robert S. Mathias, MD Date reviewed: November 2019

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