Understanding Hypertension: Causes and Treatment

In the United States, nearly half of adults have high blood pressure, or hypertension. Known as a silent killer, the condition can contribute to heart attack, stroke and heart failure without ever causing symptoms. Although it was once thought to affect mostly older people, research now shows that an increasing share of people ages 35 to 64 are dying of heart disease related to it. “Hypertension matters so much because it’s the most modifiable risk factor for cardiovascular disease, stroke and now, the evidence suggests, this may be true for cognitive decline,” says Eduardo Sanchez, MD, chief medical officer for prevention at the American Heart Association. Lifestyle changes and medication can help bring blood pressure down, which “changes the trajectory very, very dramatically” when it comes to heart attack and stroke, he says.

Even simple steps can help get your blood pressure in check. It sounds obvious, but just knowing your blood pressure is a great place to start. More than half of people with uncontrolled hypertension aren’t aware they have it, according to some estimates.

Blood pressure, the force that blood exerts on your arterial walls, is measured in millimetres of mercury (mm Hg). It is given in two numbers: The top number, systolic pressure, measures the force when blood is pumped out of your heart; the bottom number, diastolic pressure, measures the force between beats, when your heart is filling with blood.

Normal blood pressure is below 120/80 mmHg. Above that level, Dr. Sanchez says, damage begins to occur to blood vessels and the organs they supply, including the kidneys, heart and brain.

It’s important to have your blood pressure checked at least annually, says Jennifer Cluett, MD, director of the Complex Hypertension Clinic at Beth Israel Deaconess Medical Center in Boston. Make sure it’s measured the right way: with the right size cuff and when you are sitting with both feet flat on the floor, have your upper arm supported at heart level and are not talking.

“The typical setting in a busy primary care clinic—where somebody’s sitting on an exam table with their legs dangling and their arm not supported, while somebody is talking to them—is not the right way,” Dr. Cluett says.

Up to 30 per cent of patients also may experience “white coat hypertension,” which is when blood pressure levels become elevated at the doctor’s office. For this reason, blood pressure management guidelines recommend checking at home, too, to confirm a diagnosis and manage the condition.

It’s important to understand your personal risk. There can be many causes of hypertension, says Fátima Coronado, MD, associate director for science in the division for heart disease and stroke prevention of the Centers for Disease Control and Prevention (CDC). The condition develops over time as a result of both genetic and environmental factors, including smoking, excess weight and poor sleep. People whose parent or grandparent suffered a heart attack or stroke can be at increased genetic risk for high blood pressure, she says.

Age influences risk because our arteries stiffen as we get older. Additionally, hypertension is more prevalent among men than women, and more common among Black people than among White, Latino or Asian people, according to CDC data.

Some women develop high blood pressure during pregnancy, which can be dangerous to the mother and the fetus. Martha Gulati, MD, director of the Davis Women’s Heart Center at Houston Methodist Hospital, says the condition should be treated during pregnancy, and women should be followed by a cardiologist afterward because they are at increased risk of high blood pressure and cardiovascular disease.

Diet also plays a major role. You’ve heard it before: Eat healthy for your heart. Specifically, among 22 lifestyle changes and stress-reducing techniques for reducing blood pressure, the Dietary Approaches to Stop Hypertension (DASH) eating plan was found to be the most effective, according to an analysis of more than 100 studies.

One reason may be that it centers foods rich in potassium, an electrolyte that helps your body get rid of sodium and that relaxes your artery walls. Sodium causes the body to retain water, increasing the fluid—and the ­pressure—inside blood vessels.

Illustration by Kate Traynor

Bananas aren’t the only easy source of potassium: An avocado or one cup of diced cantaloupe contains even more of it than a medium banana, and citrus fruits like oranges are also rich in the electrolyte, as are leafy greens like spinach and Swiss chard.

You can lower your blood pressure further by reducing your sodium intake, Dr. Gulati says. The American Heart Association recommends that people consume no more than 2,300 milligrams of sodium per day—and ideally, much less. In the United States, most of the sodium in people’s diets comes from restaurant meals and processed foods.

Cutting down on these foods—­swapping a frozen dinner or a slice of pizza for the salad bar, for example—or making small changes in your food shopping can make a big difference. Look for low-sodium versions of sauces. Rinse canned beans and vegetables, which are often stored in salty water for preservation, before eating them.

Alcohol intake is also associated with increased blood pressure. Doctors suggest aiming for total abstinence. The benefits of cutting back seem greatest for those who usually consume more than two drinks per day.

Aerobic exercise, which strengthens your heart so it can pump with less effort, was the second most effective intervention after the DASH diet. Isometric resistance exercise—when you contract muscles and hold a position, such as a wall squat or a plank—was the third. Isometric exercise can help blood vessels dilate, which improves blood flow. Exercise also reduces stress, as can meditation, yoga, prayer and other types of religious practice, says Dr. Sanchez.

And while exercise is beneficial even if you don’t lose weight, dropping excess pounds can also help reduce blood pressure, says Dr. Cluett.

The goal of treatment is to keep the blood pressure below 130/80 mm Hg, though under 120/80 mm Hg is even better. Often, that requires medication. There are several effective generic options that doctors can prescribe.

Patients may need to take multiple types, which doctors say can sometimes be a deterrent. Single-pill combinations that include two or more blood pressure medications in one tablet are easier to take. While some medications may cause side effects like frequent ­urination or leg swelling, doctors can tweak drug regimens to mitigate those.

Even if you’re on medication, changes to your diet and exercise can still help—and can lower your odds of all sorts of negative health outcomes. As Dr. Cluett puts it: “Lifestyle changes help more than just your blood pressure number.”

The New York Times (6 February 2026); Copyright © by The New York Times Company.

For more stories like these, click here