Chronic hypertension is a condition of longstanding elevated blood pressure. Blood pressure is the pressure that blood places on your arteries as it circulates in your body. Your heart must work against this pressure to pump blood. Known as the “silent killer,” high blood pressure does not usually cause symptoms but can lurk undetected for many years while causing damage to your heart and other organs.
Read on to learn more about chronic hypertension and its causes, diagnosis, and potential negative affects on the body.
Chronic Hypertension Symptoms
High blood pressure is called the “silent killer” because of its notorious lack of symptoms. According to the American Heart Association, when blood pressure is extremely elevated, it can cause headaches and nosebleeds, but this is not the norm. Even without causing symptoms, chronic high blood pressure is dangerous as it increases the risk of heart disease, stroke, and kidney disease. For this reason, you should never rely on a lack of symptoms or assume your blood pressure is normal.
What Causes Chronic Hypertension?
Chronic hypertension has many causes. While we don’t have control over some causes like aging, and genetics, many other risk factors are manageable. The following is a list of contributors to high blood pressure:
- Aging, which causes stiffening of blood vessels over time
- Excess alcohol intake
- Poor diet
- Chronic stress
- Sedentary lifestyle
- Insufficient and poor quality sleep
- Drugs of abuse, like cocaine and methamphetamine
- Certain medications, like NSAIDs, corticosteroids, certain antidepressants, and hormonal contraception
- Medical problems like kidney disease, obstructive sleep apnea, and obesity
- Air and noise pollution
Racial Disparities in High Blood Pressure
According to a 2022 study, non-Hispanic Black adults have the highest rates of hypertension, at approximately 58% for both Black men and women. This is compared to approximately 51% prevalence for men of non-Hispanic White, Hispanic, and non-Hispanic Asian ethnicity and 41% to 42% for women of non-Hispanic White, Hispanic, and non-Hispanic Asian ethnicity.
The reasons for this and other health disparities among racial and ethnic groups appear to be multifold, with a definite contribution of social determinants of health, such as access to health care.
Diagnosis of Hypertension
Thankfully, the diagnosis of hypertension is straightforward. Blood pressure is simply measured using a blood pressure cuff. Healthcare providers measure blood pressure to screen for hypertension at your routine health exams. Hypertension is diagnosed when there has been more than one reading above 130/80 millimeters of mercury (mm Hg).
Blood pressure measurement can be done manually with a sphygmomanometer (blood pressure cuff), or using an automated arm cuff. Automated blood pressure cuffs can be found at most pharmacies. You may also purchase your own automated cuff for measuring your blood pressure at home. This can be especially useful when blood pressure is borderline or when medications are started or adjusted.
|Blood Pressure Categories According to the 2017 American College of Cardiology/American Heart Association Guidelines|
|Blood Pressure Category||Systolic Blood Pressure (mm Hg)||Diastolic Blood Pressure (mm Hg)|
|Stage 1 Hypertension||130s||80s|
|Stage 2 Hypertension||≥140||≥90|
Some Tricky Forms of High Blood Pressure to Diagnose
Some forms of high blood pressure, like white coat hypertension and masked hypertension, can be more difficult to diagnose. White coat hypertension is when your blood pressure is elevated when checked by your healthcare provider in the office, but normal at other times. Masked hypertension is when your blood pressure is normal at home, but elevated in the office. Both of these can be clarified with 24-hour ambulatory blood pressure monitoring.
How Is Chronic Hypertension Treated?
Fortunately, chronic hypertension is a treatable condition, and bringing blood pressure to goal levels can reduce the risk of heart attack, stroke, and death. Together, healthy lifestyle habits and medications can help get your blood pressure to goal levels.
Once you have been diagnosed with elevated blood pressure it’s a good idea to consider lifestyle habits that you can modify to help bring your blood pressure down. The following changes can lower your blood pressure:
- Consuming a healthy diet, with lots of fruits and vegetables and few processed foods, such as the DASH Diet or a Mediterranean Diet. This can lower your blood pressure by up to 11 points.
- Increasing physical activity with regular exercise can lower your blood pressure by up to four to eight points, depending on the type of exercise.
- Restricting salt, by avoiding things like processed foods, which are generally loaded with salt.
- Increasing potassium intake, ideally through the foods you eat. Many fruits and vegetables are high in potassium. Increasing potassium intake can lower blood pressure by five points.
- Limiting alcohol to one drink per day for women and two for men can lower blood pressure by up to four points.
- Quitting smoking significantly lowers the risk of heart disease and stroke and is a major recommendation for those with and without high blood pressure; however, the blood pressure-lowering effect is debated.
Blood Pressure Medication
While healthy lifestyle habits can make a big difference in blood pressure, many people need medications in addition to the healthy habits listed above. There are many different types of blood pressure lowering medications. Some of the most commonly used drug classes include:
- Diuretics, like hydrochlorothiazide and chlorthalidone
- ACE-Inhibitors, like benazepril and lisinopril
- Angiotensin receptor blockers (ARBs) like losartan and valsartan
- Calcium channel blockers like amlodipine and nifedipine
While any medication may have side effects, your healthcare provider can help find a medication that you tolerate well and is effective for you.
Chronic hypertension is a serious condition that may be overlooked without proper screening. It usually does not cause any symptoms but can lurk undetected and wreak havoc on your heart and other organs over time. Many risk factors for high blood pressure exist, and several are modifiable, meaning we can make healthy changes to lower risk. Diagnosis is easily performed with a blood pressure measurement, and there are many effective medications.
A Word From Verywell
If you have been diagnosed with high blood pressure, know that while it’s a serious condition, you do have control of getting your blood pressure controlled. Consider it a wake-up call to commit to the exercise program you have been meaning to get to or to make healthy changes to your diet. Small, consistent changes can have significant effects over time. And your healthcare team is there to work with you and get you on appropriate medication if needed.
American Heart Association. What are the symptoms of high blood pressure?
Centers for Disease Control and Prevention. High blood pressure symptoms and causes.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.Hypertension. 2018;71(6):1269-1324. doi:10.1161/HYP.0000000000000066
Centers for Disease Control and Prevention. Know your risk for high blood pressure.
Spruill TM, Butler MJ, Thomas SJ, et al. Association between high perceived stress over time and incident hypertension in Black adults: findings from the Jackson heart study. J Am Heart Assoc. 2019;8(21):e012139. doi:10.1161/JAHA.119.012139
Lo K, Woo B, Wong M, Tam W. Subjective sleep quality, blood pressure, and hypertension: a meta-analysis. J Clin Hypertens (Greenwich). 2018;20(3):592-605. doi:10.1111/jch.13220
Fuks KB, Weinmayr G, Basagaña X, et al. Long-term exposure to ambient air pollution and traffic noise and incident hypertension in seven cohorts of the European study of cohorts for air pollution effects (ESCAPE). Eur Heart J. 2017;38(13):983-990. doi:10.1093/eurheartj/ehw413
Tsao CW, Aday AW, Almarzooq ZI, et a. Heart disease and stroke statistics—2022 update: a report from the American Heart Association. Circulation. 2022;145:e153–e639. doi:10.1161/CIR.0000000000001052
Saeed A, Dixon DL, Yang E. Racial disparities in hypertension prevalence and management: a crisis control? American College of Cardiology. 2020.
Li G, Wang H, Wang K, et al. The association between smoking and blood pressure in men: a cross-sectional study. BMC Public Health. 2017;17(1):797. doi:10.1186/s12889-017-4802-x
Thanks for your feedback!
What is your feedback?