Myths & Facts: High Blood Pressure

High blood pressure, also called hypertension, is blood pressure (the force of blood flowing through blood vessels) that is higher than normal. While blood pressure changes throughout the day based on an individual’s activities, consistent blood pressure measures above normal may result in a diagnosis of elevated blood pressure or hypertension.

According to the Centers for Disease Control and Prevention (CDC), nearly half of adults age 30 to 79 years of age have hypertension (48.1 percent, 119.9 million), defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg, or are taking medication for hypertension. 

High blood pressure affects more men (50 percent) than women (44 percent), and it is more common in non-Hispanic black adults (56 percent) than in non-Hispanic white adults (48 percent), non-Hispanic Asian adults (46 percent) or Hispanic adults (39 percent). In addition, rates of high blood pressure vary by geography.¹

Hypertension is no joke. It puts individuals at risk for heart disease and stroke, which are leading causes of death in the United States. Indeed, in 2021, hypertension was a primary or contributing cause of 691,095 deaths in the United States.1 And yet, an estimated 46 percent of adults with hypertension are unaware they have the condition,² which is why it is called the silent killer. The only methods to curtail the dangers of high blood pressure are to educate the public, encourage regular blood pressure monitoring and to dispel the many myths surrounding it.

Separating Myth from Fact

Myth: A person doesn’t have high blood pressure if he or she feels fine. 

Fact: It is true that people with severe high blood pressure may experience difficulty breathing, headaches, vision changes, chest pain and more. But others may never feel a thing.³ The reason high blood pressure is called the silent killer is because most people are unaware they have it, which means they are unaware it is damaging their arteries, heart and other organs.⁴ The only way to detect hypertension is to measure blood pressure.

“Unless your blood pressure is dangerously high, you will not have any symptoms,” explains Parveen Garg, MD, a cardiologist at Keck Medicine of the University of Southern California (USC) and associate professor of clinical medicine and population and public health sciences at the Keck School of Medicine of USC. “The long-term damage high blood pressure has on your arteries, however, occurs regardless of whether you have symptoms or not.”⁵

Myth: High blood pressure is inevitable with age. 

Fact: Actually, it is not inevitable, and it is not a normal part of aging. Hypertension is more common among older adults, but it occurs in middle-aged and young adults, too. Statistics show that hypertension affects around 7.5 percent of people aged 18 to 39 years, 33.2 percent of people aged 40 to 59 years and 63.1 percent of individuals over the age of 60 years.⁶

Myth: High blood pressure is OK as long as one number is normal. 

Fact: Both numbers matter. Blood pressure is measured using two numbers. The top number is systolic blood pressure, which is the pressure in blood vessels when the heart beats. If the number is higher, the blood exerts more pressure against the artery walls during each contraction of the heart muscle. The bottom number is diastolic blood pressure, which is the pressure in the blood vessels in between heartbeats. A normal diastolic number is lower than 80. 

According to United Healthcare, the top and bottom numbers in healthy adults usually add up to around 120 over 80. If these numbers are too low or too high, there might be a problem. For example, someone with high blood pressure may have a systolic reading of 130 to 139 or a diastolic reading of 80 to 89. The higher the numbers go, the more at risk individuals may be for heart attack or stroke. However, it is true that the top number (systolic) is given more attention as a way to figure out if an individual may be at risk for heart disease.⁷

“While high blood pressure used to be defined as over 140/90 mm Hg, that definition has changed in the past few years,” explains Dr. Garg. “Today, if someone has blood pressure over 130/80 mm Hg and has a history of cardiovascular disease — or, if they are at high risk for having a cardiovascular event — their physician may recommend taking blood pressure medication.”⁵

Myth: High blood pressure can’t be prevented. 

Fact: Many people believe if parents or close blood relatives have had high blood pressure, they are more likely to develop it, too. But high blood pressure can be avoided by engaging in healthy lifestyle changes, including:

• Keeping weight at a healthy level. Being overweight puts extra strain on the heart, increasing the risk for developing high blood pressure and damage to blood vessels. Even losing as few as 10 pounds can help manage or prevent high blood pressure in many overweight people (those with a body mass index, or BMI, of 25 or greater).⁸

• Eating a healthy diet, and limiting salt intake. Sodium (salt) encourages the body to retain fluid, which can increase the fluid volume of blood and raise blood pressure. According to Amanda Stathos, a clinical dietitian at Johns Hopkins’ Sibley Memorial Hospital, the recommended minimum daily sodium intake requirement is about 1,500 milligrams a day, with the upper limit at 2,300 mg, which is equal to only about one teaspoon of salt. Lowering salt intake can be accomplished by cooking low-sodium dishes; substituting salt (including kosher and sea salt⁴) with spices such as garlic, turmeric and paprika, which add flavor and other health benefits; avoiding processed foods (or when using, checking the nutrition labels4); and using the DASH (dietary approaches to stop hypertension) diet, which is not only low in sodium, but very high in nutrition, or the Mediterranean diet, which is based on a diverse range of unprocessed foods.⁹

• Limiting alcohol intake. Blood pressure can be raised to unhealthy levels from drinking too much alcohol. According to Francisco Lopez-Jimenez, MD, chair of the division of preventive cardiology at Mayo Clinic, consuming more than three drinks in one sitting temporarily raises blood pressure, and repeated binge drinking can lead to long-term increases in blood pressure.

Following are the definitions of excessive drinking:

1) Binge drinking is defined as four or more drinks within two hours for women and five or more drinks within two hours for men.

2) Moderate drinking is up to one drink a day for women and two for men.

3) Heavy alcohol use is defined as more than three drinks a day for women and four for men.

Also, individuals should keep in mind that alcohol contains calories and may cause weight gain, which as mentioned previously, is a risk factor for high blood pressure.¹⁰

• Not smoking tobacco or avoiding exposure to it. According to an article in MedicalNewsToday, every time a person smokes, it produces a temporary increase in blood pressure. Typically, smoking one cigarette raises a person’s heart rate and blood pressure for 15 to 30 minutes. So, when people smoke frequently, this effect happens over and over throughout the day. Smoking two cigarettes per hour can lead to a 5 to 6 mm Hg increase in daytime blood pressure. 

Studies show that nicotine can raise blood pressure because it stimulates the release of epinephrine and norepinephrine — hormones that underlie a person’s fight-or-flight response. Epinephrine and norepinephrine can cause the smooth muscles in certain blood vessels to contract, narrowing the opening and reducing the space through which blood can flow, which results in increased blood pressure.

Smoking — as well as exposure to secondhand smoke — can also damage the walls of blood vessels and raise the likelihood of atherosclerosis — the accumulation of fatty substances called plaque inside the arteries. Consequently, plaque buildup can narrow the blood vessels and contribute to high blood pressure.¹¹

• Getting regular exercise. Exercise can actually lower blood pressure. According to the Mayo Clinic, “Regular exercise makes the heart stronger. A stronger heart can pump more blood with less effort. As a result, the force on the arteries decreases. This lowers blood pressure.”¹²

The simple rule is to move more and eat well. The American Heart Association recommends people gradually increase their level of physical activity beyond the recommended 150 minutes of moderate-intensity aerobic activity per week, decrease the number of calories taken in and eat a healthy diet.⁸ 

• Not letting stress build up. Both acute (short-term) and chronic (long-term) stress can affect the cardiovascular system by changing hormone levels. While temporary spikes in blood pressure in response to acute stress are normal and expected, chronic stress may lead to high blood pressure. The American Heart Association suggests managing stress by exercising regularly, making time for friends and family, getting enough sleep, maintaining a positive attitude, practicing relaxation techniques and finding a stimulating hobby.¹³

Myth: A person doesn’t need to check his or her blood pressure regularly if it’s being monitored by a physician. 

Fact: While home monitoring, or self-measured blood pressure, is not a substitute for regular visits to a physician, the American Heart Association recommends home monitoring for all people with high blood pressure to keep their healthcare professional aware of whether treatments are working.¹⁴

Individuals should follow these American Heart Association’s tips to ensure their blood pressure readings are correct:¹⁴ 

• Be still; don’t smoke, drink caffeinated beverages or exercise within 30 minutes; empty the bladder; and ensure at least five minutes of quiet rest before measurements.

• Sit correctly with the back straight and supported, feet flat on the floor, legs uncrossed and the arm supported on a flat surface such as a table with the upper arm at heart level.

• Measure at the same time every day, ideally beginning two weeks after a change in treatment and during the week before the next doctor appointment.

• Take multiple readings, and record the results each time.

• Don’t take measurements over clothes.

Myth: High blood pressure treatments don’t work and cause too many adverse side effects. 

Fact: In some instances, blood pressure treatments don’t work, and if that’s the case, the physician will often recommend a hypertension specialist to look for potential causes^.15 However, in most instances, blood pressure medications do work, and most of the time, only a single drug will be used at first, while two drugs may be started for stage 2 high blood pressure, which is when blood pressure is equal to or higher than 140/90 mm Hg. Medline Plus says one or more of these blood pressure medicines are often used to treat stage 2 blood pressure:

• Diuretics, also called water pills, help kidneys remove some salt (sodium) from the body so blood vessels don’t have to hold as much fluid and blood pressure goes down.

• Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) reduce the production of angiotensin II in the body, helping to relax blood vessels, which lowers blood pressure.

• Angiotensin II receptor blockers (also called ARBs) reduce the action of angiotensin II in the body, helping to relax blood vessels, which lowers blood pressure.

• Calcium channel blockers relax blood vessels by reducing calcium entering cells in the wall of the blood vessels.

• Beta-blockers make the heart beat at a slower rate and with less force; these have been commonly used, but are now usually only used if the drugs above are not adequate or cannot be used.

Blood pressure medicines that are not used as often include:

• Alpha-blockers that help relax blood vessels, which lowers blood pressure.

• Centrally acting drugs that signal the brain and nervous system to relax blood vessels.

• Vasodilators that signal the muscles in the walls of blood vessels to relax.

• Renin inhibitors that act by reducing the amount of angiotensin precursors, thereby relaxing blood vessels.

All of these medicines have side effects, but most are mild and may go away over time. Some common side effects of high blood pressure medicines include:

• Cough

• Diarrhea or constipation

• Dizziness or lightheadedness

• Erection problems

• Feeling nervous

• Feeling tired, weak, drowsy or a lack of energy

• Headache

• Nausea or vomiting

• Skin rash

• Weight loss or gain without trying

If side effects cause problems, making changes to the dose of medicine or the time it’s taken can help reduce side effects.¹⁶

Myth: Treatment for high blood pressure can be stopped if it’s working. 

Fact: While blood pressure readings may turn to normal when taking medication, hypertension is a lifelong condition so it’s important for individuals to follow their doctors’ recommendations and only reduce or stop taking the medication when they have confirmed that this is the best course of action. 

The American Heart Association says, “Expect to treat high blood pressure for life. Doctors will sometimes reduce a [person’s] drug dosages after achieving normal blood pressure and maintaining it for a year or more, although it is rare for the treatment to be stopped entirely. Some form of treatment must be continued over a lifetime for good results.”⁶

Dispelling the Myths Now

Researchers continue to explore ways to prevent and manage high blood pressure and its effects. At Johns Hopkins Medicine, researchers are studying antihypertensive drugs to see if they may help preserve cognitive function in people with high blood pressure. Researchers are also studying the link between higher weight and weight gain and the risk of high blood pressure.¹⁷

The National Heart, Lung and Blood Institute is another organization that leads and supports research and programs on high blood pressure. It has funded studies and programs to help develop new treatments for high blood pressure, many of which focus on women’s health, lifestyle interventions and health disparities. Current studies aim to prevent pregnancy complications and improve blood pressure among people in high-risk groups.¹⁸

One of the global targets for noncommunicable diseases is to reduce the prevalence of hypertension by 33 percent between 2010 and 2030. In 2021, the World Health Organization released a new “Guideline for the Pharmacological Treatment of Hypertension in Adults,” which provides evidence-based recommendations for the initiation of treatment of hypertension, and recommended intervals for follow-up. The document also includes target blood pressure to be achieved for control, and information on who, in the healthcare system, can initiate treatment.²

With more research, greater understanding and dispelling the myths about this silent killer, it is hoped that healthcare providers can help to save a growing number of patients succumbing to hypertension.