What people should do about high blood pressure, according to a doctor

By Katia Hetter, CNN

(CNN) — Nearly half of American adults have high blood pressure, according to the US Centers for Disease Control and Prevention. Hypertension, another word for high blood pressure, is a major contributing factor to heart disease and stroke, which are leading causes of death worldwide. In the US, 1 in 5 adults with hypertension don’t know that they have it.

How common is hypertension, and why is it important to be diagnosed? How is it treated? Besides medications, what are lifestyle factors that can help to reduce high blood pressure? For people newly diagnosed with high blood pressure, what is the most important thing to change first?

To find out more, I spoke with CNN wellness expert Dr. Leana Wen, who is an emergency physician and adjunct associate professor at George Washington University. She previously served as Baltimore’s health commissioner.

CNN: Let’s start with some facts. What is hypertension, and how does high blood pressure lead to health problems?

Dr. Leana Wen: Blood pressure is measured in millimeters of mercury or mmHg. It has two readings: Systolic (the top number) measures the pressure in the arteries when the heart beats, and diastolic (the bottom number) measures the pressure in the arteries between heartbeats. Hypertension is generally defined as blood pressure at or above 130/80 mmHg. This is called stage 1 hypertension. Stage 2 is when blood pressure is consistently 140/90 mmHg or above. Hypertensive crisis is when it is 180/120 mmHg. The treatments from your medical provider will differ depending on your blood pressure and accompanying symptoms, if any.

High blood pressure can damage multiple organs in the body. The condition can damage arteries and lead to heart disease. Hypertension can cause arteries that supply blood to your brain to be blocked or to burst, leading to a stroke. It is also a cause of chronic kidney disease. People with chronic hypertension have elevated risks for other conditions, including a greater chance of developing dementia. And high blood pressure can be fatal if left untreated. Hypertension is a primary or contributing cause of more than 691,000 deaths in the US in 2021, according to the CDC.

CNN: Will people know they have hypertension based on whether they have symptoms?

Wen: Some people experience symptoms such as chest pain, headaches and blurry vision. However, these symptoms are signs of organ damage and therefore are late signs of hypertension. Most people who have high blood pressure do not have symptoms. This is why blood pressure screening is so important.

CNN: How common is hypertension? Are there some groups that are at higher risk than others?

Wen: Hypertension is among the most common diseases, impacting an estimated 48% of US adults. In the US, a greater percentage of men have hypertension than women. The condition is also more common in non-Hispanic Black adults than in non-Hispanic Whites, Hispanics and Asians. The reasons for these differences are complex and include a combination of biological and social factors. Also, individuals with a family history of high blood pressure are more likely to have high blood pressure themselves, and people at older ages are more likely to have hypertension.

Worldwide, according to the World Health Organization, an estimated 1.28 billion adults ages 30 to 79 have hypertension. Nearly half are unaware that they have the condition, and just 42% with the disease are diagnosed and treated.

CNN: How is hypertension treated?

Wen: There are two general categories of treatment for hypertension: medications and lifestyle changes.

There are many types of medications approved to treat high blood pressure. They include diuretics that help the body to get rid of excess sodium and water, beta-blockers that reduce the heart rate and therefore the heart’s workload, and calcium channel blockers and angiotensin-converting enzyme inhibitors (ACE inhibitors) that relax and open up blood vessels.

There are pills that combine medications in different classes. Some people start with one medication and then are switched to another. Some others need two or more medications.

In addition to taking medications, patients diagnosed with high blood pressure are recommended to change aspects of their lifestyle that elevate their blood pressure. These are similar lifestyle changes people can also use as preventive measures, meaning that they can prevent hypertension in those who aren’t yet diagnosed with it.

CNN: What lifestyle changes can people make to better control their blood pressure?

Wen: I advise people to take an inventory of five key daily habits.

First, what is your level of physical activity? The CDC recommends at least 150 minutes per week of exercise that is at least of moderate intensity. There are substantial benefits to health at even half that recommended amount, studies have shown. People should also evaluate how often they get up to move during the day, as desk-bound workers may need additional exercise to compensate for their prolonged sitting.

Second, what is your current diet? Is it already quite healthy, with plenty of whole foods including fruits, vegetables and whole grains, or does it include large amounts of saturated fats and ultraprocessed foods?

Third, how much do you smoke, drink alcohol and use other substances? Smoking, drinking excessive alcohol and using substances like marijuana and cocaine can substantially increase the risk of heart disease. They can also make hypertension harder to control and can compound the negative impacts of high blood pressure.

Fourth, what is your level of stress? Studies have linked higher stress levels to increased blood pressure, as well as cardiovascular disease such as heart attack and stroke.

Fifth, are you at a healthy weight? Obesity is a risk factor for hypertension. People who are in the category of being overweight are also more likely to have high blood pressure. Reducing weight through lifestyle changes and/or through medications will also result in better blood pressure control.

CNN: How important is each intervention? Could you rank them in order of what people should do first?

Wen: It depends on the individual. I’d recommend that people make the inventory of the five areas and then look at which area needs the most improvement, as well as the area that is easiest to change.

For instance, someone who does not exercise at all would benefit from starting with some physical activity. Another person who is quite physically active but smokes should consider smoking cessation. Yet another who is a nonsmoker but eats fast food all the time should start with rethinking diet.

People should also be honest about what changes they can make and sustain. You don’t have to do everything perfectly to make a difference in your health. Another good strategy is to start with the low-hanging fruit — the changes you can make quickly and that don’t require a huge shift in your lifestyle. Many people can’t easily reduce stress in their lives, but maybe they can more easily start eating more fruits and vegetables.

CNN: For patients newly diagnosed with high blood pressure, what is the most important thing to change first?

Wen: This depends on the individual. I’d recommend that everyone ask their health care provider and work with them on identifying the key changes that you have to make right away.

Someone who is diagnosed with blood pressure that is just a little bit elevated may be able to begin with lifestyle changes alone. On the other hand, it’s crucial for someone with very high blood pressure to take medications immediately. That is the single most important intervention they need to make.

In general, I would urge people not to delay taking medications if they are needed. Medications to reduce high blood pressure have been around for decades. They are safe and effective, and many options exist so that if you experience side effects, you can switch to another. You can work on improving your lifestyle habits at the same time. Some patients end up not having to take medications once their lifestyle changes improve. But do not put off medications.

Remember as well that controlling hypertension is something you need to take on as a long-term commitment to your health. The damage that hypertension does to your body accumulates over time, but there are many steps you can take to control your blood pressure and keep yourself healthy and well.

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