Hypertension: Causes, Consequences, and New Shifts in Understanding

A week ago, 32% of the U.S. adult population was identified as having high blood pressure; as of last Monday, that population increased to 46%.[1] The reason for this sudden and dramatic increase is the fact that the American Heart Association, the American College of Cardiology, and a handful of other health associations elected to change the threshold for high blood pressure from a reading of 140 over 90 to a reading of 130 over 80.[2] Why this change and what effects will it have on the practice of medicine? Why is high blood pressure such a concern in this country to begin with? In an attempt to answer these questions, here’s an overview of hypertension and the research and changes that are reshaping how it’s being thought about:


What is hypertension?

Hypertension, also known as high blood pressure (HBP), means that the force exerted by blood against the walls of the blood vessels is greater than it should be.[3] This high level of force is due to the fact that the heart is doing more work than it’s intended to do.[4]


Causes and consequences of hypertension

While temporary hypertension can happen in healthy individuals and not have long-term effects, such as while experiencing moments of acute stress or intense exercise, many people develop HBP on account of age, diet, stress, genetics, and existing health conditions.[5] Those who have heart disease, chronic kidney disease, or diabetes are particularly at risk of developing HBP.[6]  Since excessive pressure on artery walls can damage blood vessels and other internal organs, high blood pressure can lead to serious bodily harm if left uncontrolled.[7] Specifically, it can lead to heart attack, stroke, aneurysm, heart failure, metabolic syndrome, or weakened and narrow blood vessels in kidneys.[8] Because high blood pressure doesn’t exhibit any symptoms, it may exist in people who appear completely healthy, hence why it is known as a “silent killer.”[9]


Why are views about hypertension shifting?

Research over the last few years has demonstrated that previous assumptions about blood pressure management were misinformed; only if blood pressure is brought down to 120 is the risk of heart attack and stroke significantly decreased.[10] The 21 experts who gathered to make the decision to change the blood pressure target from 140/90 to 130/80 were unanimous in endorsing this lower threshold for high-risk individuals.[11] The hope is that in labeling more people with hypertension, drug treatment will be recommended earlier and risk will be reduced.[12]


Potential Effects

NPR reporters conducted an analysis and estimate that under the new guideline, “8 million more people would be recommended to start blood pressure drugs and an additional 14 million would be advised to have their current therapy increased.”[13] While many leaders of the guideline change believe HBP can be addressed through lifestyle changes like losing weight, eating healthier, exercising more, and consuming less alcohol without the need for medication,[14] giving a prescription will always be the easiest fix. Physicians and patients will have to engage in more conversations together about how to address this new reality; new tools and methods are needed to help patients make informed decisions and about what is best for them.[15]


The former director of the CDC, Thomas R. Frieden, has said that hypertension is “the world’s most under-addressed preventable health problem.”[16] New hope, however, is provided by the new HBP guidelines, which have the potential to draw attention to this problem, reduce risk, and save the lives of thousands of Americans.

[1] Bernstein, Lenny and Ariana Eunjung Cha, “Blood pressure of 130 is the new ‘high,’ according to first update of guidelines in 14 years,” The Washington Post, Nov. 13, 2017, https://www.washingtonpost.com/news/to-your-health/wp/2017/11/13/blood-pressure-of-130-is-the-new-high-according-to-first-update-of-guidelines-in-14-years/

[2] Ibid

[3] MacGill, Markus, “Hypertension: causes, symptoms, and treatments,” Medical News Today, July 17, 2017, https://www.medicalnewstoday.com/articles/150109.php

[4] Ibid

[5] Bernstein and Cha, “Blood pressure”

[6] Krumholz, Harlan, “With Stricter Guidelines, Do you Have High Blood Pressure Now?” National Public Radio, Nov. 14, 2017,  https://www.npr.org/sections/health-shots/2017/11/14/564038552/with-stricter-guidelines-do-you-have-high-blood-pressure-now

[7] “High blood pressure (hypertension): Complications,” Mayo Clinic, n.d., https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/basics/complications/con-20019580

[8] Ibid

[9] Bernstein and Cha, “Blood pressure”

[10] SPRINT Research Group, “A Randomized Trial of Intensive versus Standard Blood-Pressure Control,” New England Journal of Medicine, Nov. 26, 2015, http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleTop

[11] Krumholz, “With Stricter Guidelines”

[12] Ibid

[13] Ibid

[14] Bernstein and Cha, “Blood pressure”

[15] Krumholz, “With Stricter Guidelines”

[16] Bernstein and Cha, “Blood pressure”