According to the CDC, high blood pressure affects nearly 1 in 2 adults in the United States. But did you know that African Americans have higher rates of high blood pressure than other racial and ethnic groups? They also develop high blood pressure at a younger age. African Americans are more likely to develop complications associated with higher blood pressure such as heart attack and heart failure, aneurysms, stroke, kidney disease, dementia etc. They are also less likely to have their blood pressure controlled on multiple medications.  

What is High Blood Pressure? 

High blood pressure (hypertension) is a common condition where the force exerted by the circulating blood against the artery wall is high enough that it may eventually cause problems such as stroke, heart disease and kidney disease. Most people with high blood pressure do not have symptoms even when the blood pressure is dangerously high. When symptoms occur, they include headaches, fatigue, chest pain, palpitations, confusion, nausea and vomiting and vision changes.  

Blood Pressure by the Numbers 

The blood pressure reading includes two numbers. The top number, called systolic blood pressure, is the force of blood through the arteries during heartbeats. The bottom number, called diastolic blood pressure, is the force of blood through the arteries in between heartbeats.    

Systolic blood pressure:

119 or below = normal
120 – 129 = elevated 
130 – 139 and greater = stage 1 high blood pressure 
140 and higher = stage 2 high blood pressure 
180 or above = hypertensive crisis 

Diastolic blood pressure:

79 or below = normal 
79 or below, combined with 120 – 129 systolic = elevated 
80 – 89 = stage 1 high blood pressure 
90 and greater = stage 2 high blood pressure 
120 or above = hypertensive crisis 

Risk Factors  

There are modifiable (things you can change) and non-modifiable risk factors (things you cannot change) for high blood pressure. Modifiable risk factors include unhealthy diets such as excessive salt consumption, high saturated and trans fat diet and low fruit and vegetable intake. Other factors include physical inactivity, weight increase, consumption of alcohol and tobacco, and socioeconomic inequalities. Non-modifiable risk factors include increasing age, genetic predisposition and family history of high blood pressure.  

Causes  

There are two types of hypertension. Primary (essential) hypertension and secondary hypertension. Primary hypertension occurs when abnormally high blood pressure is not due to other medical conditions. It tends to develop gradually over many years. Secondary hypertension is a form of abnormally high blood pressure that has a distinct cause. Conditions that can cause secondary hypertension include kidney disease, obstructive sleep apnea, adrenal gland disease, pheochromocytoma (a type of tumor in the adrenal glands), preeclampsia (a pregnancy complication), thyroid diseases, birth control pills, decongestants, over the counter pain pills (NSAIDs), and illicit drugs such as cocaine and amphetamine. 

Prevention  

Simple changes such as changing your diet, increasing your physical activity and losing weight can help prevent high blood pressure. 

Diet  

Diet plays an important role in the development of high blood pressure. The Dietary Approaches to Stop Hypertension (DASH) diet plan has been shown to lower blood pressure. It includes foods that are rich in potassium, magnesium and calcium, which are nutrients that help control blood pressure. This includes vegetables, fruits, whole grains, fat-free or low-fat dairy products, fish, poultry, beans and nuts. The diet plan limits foods that are rich in sodium, saturated fat and added sugar. You should also reduce salt intake to less than 2,300 mg per day. You can do this by using sodium-free spices or flavoring instead of salt, avoiding processed foods, choosing fresh or frozen skinless poultry, fish and lean meats, and checking food labels to ensure they are low-sodium or no-salt. A dietitian can help you find creative ways to meet these goals without giving up your favorite foods.  

Physical Activity 

A sedentary lifestyle is linked to many chronic health conditions, including blood pressure. Regular exercise makes a stronger heart, which can then pump more blood with less effort. This results in less force exerted on the artery walls, therefore lowering blood pressure. Many studies have shown that moderate aerobic activity of 30 minutes a day for at least five days a week helps lower blood pressure. The impact on blood pressure is seen after one to three months of regular aerobic exercise, and it persists with continued exercise. Aerobic exercises are activities that will increase heart and breathing rate, and they include brisk walking, jogging, swimming, climbing stairs, dancing, bicycling, active sports, etc. Physical activity also helps with weight loss.  

Weight Loss 

Weight loss is one of the most effective lifestyle changes for controlling elevated blood pressure. It has been reported that each kilogram (about 2.2 pounds) of weight loss may reduce blood pressure by approximately 1 mmHg.  

Managing High Blood Pressure  

There are several things you can do to help control or lower your high blood pressure.  

Medication 

Persistently high blood pressure that does not improve with conservative management will require medications for optimal control. There are multiple classes of medications used to treat high blood pressure, and it is common to take more than one drug to achieve blood pressure control. Full compliance with these medications is important to achieve a sustained effect on blood pressure control.  

Reduce Stress 

Several studies have identified chronic stress as a risk factor for high blood pressure. Stress results in an increase of stress hormones in the body. These hormones make the body retain more salt and water, thereby contributing to high blood pressure. It is important to reduce stress or at least find ways to cope with stressful situations, such as managing your expectations, focusing on issues that can be solved and making plans to solve them, making time for relaxation, and avoiding stress triggers.  

Lifestyle Changes  

Lifestyle changes such as weight loss and monitoring, quitting cigarette smoking, moderate intensity exercise, healthy eating and limiting alcohol use will contribute to blood pressure control.  

Home Blood Pressure Monitors  

Home blood pressure devices are widely available and do not require a prescription. They allow patients to take their blood pressure in a more relaxed setting at home and monitor the blood pressure to ensure that the lifestyle changes and prescribed medications are working. It is important to talk to your doctor before getting started and to develop a plan on the frequency of monitoring and plan of action if a blood pressure reading is significantly high.  

Don’t Forget Your Screenings!  

It is important that you maintain regular checkups with your physician and screen early for blood pressure. The US Preventive Services Task Force recommends blood pressure screening at age 18, and it is reasonable to measure blood pressure at least every two years. A yearly blood pressure measurement is recommended in those age 40 or older or those ages 18 to 39 with a high risk for high blood pressure. For individuals without access to primary care physicians, free blood pressure screenings are often offered at health fairs, local pharmacies and other locations in the community.  

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