“I was late rushing over here.” “Traffic was terrible.” “I just had a cup of coffee.” “Work’s been really stressful.” “My blood pressure’s only high when I’m here in the office. I can feel when it’s high and it’s never high at home.”

For some reason, when I mention that someone’s blood pressure (BP) is high (also called hypertension when it’s consistently high) more often than not some reason is given to explain it away. And there can be some truth to some of these reasons. For example, “white coat hypertension,” where someone’s BP seems to mostly be high from tensing up in the doctor’s office, is a real thing. However, even here, those who have it have been found to have increased risk compared to those who don’t.

The bottom line is that high BP is:
• extremely common, with about one in three adults, as well as many children (19% of boys and 13% of girls and rising) having it
• usually without symptoms (until it causes a catastrophe such as stroke, heart attack, heart failure, an aneurysm, kidney failure or loss of vision)
• crippling and/or deadly, as seen from the list of severe consequences noted above

So high BP is common and deadly but silent for years and so often ignored. In fact only about half of those with high BP have it under control. Although lots of folks think they can feel it when their BP is high, it turns out that when this is tested, almost no one can reliably tell whether there BP is high unless it is extreme (like 220/120). And we don’t want our first clue that we’ve had untreated high BP to be that we wake up with the squeezing chest pain of a heart attack, or that we suddenly can’t speak right, or our left side isn’t moving because we’re having a stroke. So the bottom line is you need to measure BP, preferably at various times of the day under varying levels of stress to get a sense of where your range is.

What’s recommended as a healthy BP? Well that number may have recently gotten a bit lower. In a recently published study, those treated to a BP under 120/80 did so much better compared to those only treated to the less aggressive goal of under 140/90 that the study was stopped early. It was considered unethical to not treat all of the patients to the lower goal. The top number (systolic) proved to be particularly important to control aggressively. Specifically, the group taken down to the lower (120/80 or below) goal had a 27% lower incidence of events such as heart attack and stroke. This study was comprised of folks who were over 50 years old and had at least one other risk factor for heart disease or stroke.

So, we can reasonably say that for the over 50 crowd with at least one other risk factor (such as smoking, diabetes, high cholesterol, family history of heart disease), shooting for the 120/80 goal is ideal if it can be done without a lot of side effects. Only about 5% of folks treated to the lower (120/80) goal had substantial side effects such as light-headedness with standing. And the percentages weren’t that different in the 140/90 treatment group.

Okay, then how do we treat high BP?
• If you smoke, you really need to quit
• Slowly shave off those extra pounds
• Regular aerobic exercise if your doctor clears you for it (such as a 3-4 MPH walk for 30 minutes at least every other day)
• Choose low salt foods (60% of people with high BP are made worse by high salt intake)
• No more than 1 (for women) or 2 (for men) alcoholic drinks per day
• Avoid decongestants and anti-inflammitants — they raise BP
• Manage stress (always easier said than done)

If in spite of your efforts the numbers just aren’t getting where they should be, it’s time to talk with your doctor about medicine options. It may not excite you to take a medicine, but it beats a stroke, heart attack or any of the other problems on the list. And there are enough medicine choices where you can almost always find one (or a combination) that doesn’t hassle you with side effects.

If I can be appropriately dramatic, untreated high BP is kind of like an axe murderer who we let hang around our home because he is quiet and polite and mostly stays out of our way… until one day he strikes, devastatingly. Likewise, when we treat high BP we won’t necessarily feel any better. But we will have tied up the murderer in a corner so that he can’t harm us.

So see if high BP is lurking quietly around your house. And if you find him, don’t explain him away; take him seriously, tie him up and then check on him often enough to be sure he stays put.