High Blood Pressure A Silent Killer

High blood pressure often runs silent and deep, stealthily building and cloaking its symptoms. As it continues along its insidious path, it can affect organ function and lead to serious and deadly consequences.

“It” is hypertension, more commonly known as high blood pressure within the artery walls. There are myriad causes of high blood pressure including genetic factors, hormonal imbalances, a high salt diet, obesity, sleep apnea and stress.

“It’s been called the ‘silent killer’ for ages because hypertension does not seemingly have obvious symptoms in many cases," said Babu Doddapaneni, MD, a cardiologist with Franciscan Physician Network Indiana Heart Physicians in Indianapolis. “The more reported symptoms are fatigue and throbbing headaches centered behind the eyes.”

Key Takeaways: High Blood Pressure

• High blood pressure can lead to serious health problems, including heart disease, vision and kidney problems, and stroke.
• It’s important to have your blood pressure measured and to understand what your numbers mean.
• Hypertension treatment can include blood pressure medication and lifestyle changes.

What Does Blood Pressure Mean?

"When the heart contracts or squeezes, the blood is pushed out of the heart against the blood vessels and the force with which the blood is pushed out is measured with the machine and that's what's called blood pressure," Dr. Doddapaneni said. 

Blood pressure is measured by two numbers. The top number, systolic blood pressure, measures the maximum pressure in your arteries when your heart beats. The bottom number, for diastolic blood pressure, measures the pressure in your arteries when your heart rests between beats. For a normal blood pressure of 120/80, the systolic blood pressure would be 120 and the diastolic blood pressure would be 80.

What Is Normal Blood Pressure?

"The guidelines have been updated recently, so they have made it a little stricter," Dr. Doddapaneni said. "So ideally the numbers should be below one 20 over 80. The top number is one 20, bottom is 80, but between one 20 over 80 and one 30 over 80 is considered borderline."

What Blood Pressure Level Is Considered Hypertension?

Blood pressure categories in the updated guidelines, according to the American Heart Association, are:

• Normal: Less than 120/80 mm Hg;
• Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80;
• Stage 1: Systolic between 130-139 or diastolic between 80-89;
• Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
• Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

Who Is At Risk For Hypertension?

Hypertension affects nearly half of adults in the U.S., according to a 2025 report from the American Heart Association. If left untreated, high blood pressure can cause heart attacks, strokes, kidney failure and atrial fibrillation. At high risk are those over the age of 65 with existing conditions such as diabetes or a family history of high blood pressure.

"There is a tendency to more hypertension in African-Americans," said Ghaith M Nahlawi, MD, cardiologist with Franciscan Physician Network Specialty Clinic Lafayette. "Men tend to get it at a younger ages than women."

Is Hypertension Genetic?

Hypertension can have genetic links.

“There are definitely clusters of hypertensions that run in families at younger ages," Dr. Nahlawi said. "There are also types of kidney disease, like polycystic kidney disease, that run in families that can almost always have blood pressure problems with them, as well as a variety of other kidney disorders can as well.”

Why Does Hypertension Matter For Your Health?

"Hypertension is a word that just means that the pressure in the arteries is high, higher than normal," Dr. Nahlawi said. "The reason it's important is because your blood pressure determines how much blood goes everywhere in your body. But it also determines how much stress many of your organs will face.

"Your heart is a muscle. Your heart muscle, if it has to pump against the high blood pressure, would do the same thing your biceps will do if you curl a heavy weight: it'll grow. And that can cause it to get thick, and that thickness can actually be harmful. The heart muscle needs the right amount of blood pressure, not too much and not too little.

"Other organs are very sensitive to blood pressure as well, especially the brain and the kidneys. People with very high uncontrolled blood pressure for a very long period of time have a high risk of having a stroke or having kidney disease or even going on dialysis down the road."

Other complications of hypertension include:

• Heart muscle hypertrophy
• Heart attack
• Congestive heart failure
• Strokes
• Vision problems
• Kidney problems 

What Are Symptoms Of High Blood Pressure?

May adults with high blood pressure are unaware that damage is being done, according to the American Heart Association. There are usually no signs or symptoms of high blood pressure, hence its nickname of "the silent killer."

How Is Hypertension Treated?

There are many ways to treat hypertension, including medication and liftestyle changes. These include:

• Adding physical activity — at least 30 minutes, five days per week
• Incorporating the DASH diet, a high blood pressure diet that lowers salt while increasing consumption of fresh fruits, vegetables and whole grains
• Quitting smoking
• Limiting or avoiding alcohol
• Losing weight

Medications may be added if lifestyle changes are not enough to maintain healthy blood pressure.

“With Stage 2 hypertensive patients, we rely on blood pressure medications from the time we identify a patient rather than Stage 1, which we can try lifestyle changes such as reduction in dietary sodium and weight loss,” Dr. Doddapaneni said.

Among the medications that are used to treat Stage 2 hypertension are diuretics, beta-blockers and alpha-blockers, calcium channel blocker and ACE inhibitors, which relax blood vessels as well as decrease blood volume, thereby lowering blood pressure and decreasing oxygen demand from the heart.

“When it comes to medications for high blood pressure, it's mostly trial and error in what kind of side effects the patient can tolerate. There's really no right or wrong answer for it. It's just a matter of what works the best with the least amount of side effects and has the fewest number of pills so that patients will actually take them,” said Dr. Nahlawi.

According to the U.S. Centers for Disease Control and Prevention, high blood pressure medications help by:

• Regulating fluid balance and salt levels
• Relaxing blood vessels that may have stiffened with age
• Causing the heart to beat with less force
• Controlling the nerves that restrict the blood vessels

One or a combination of these medications may be needed to get blood pressure under control. In general, blood pressure medications are low-risk but can cause some symptoms such as dizziness, headaches and swelling. Medications may need to be adjusted to minimize side effects and risks, the CDC added.

How Can I Keep Track Of Blood Pressure At Home?

"Automatic blood pressure monitors are everywhere, and the majority of them really work pretty well," Dr. Doddapaneni said. "All you need to do is get the monitor that measures automatically and measure it at home. But one thing to remember, when patients or anybody that tries to measure this at home, they have to sit down and rest for at least five to 10 minutes before they start checking the pressure. And preferably, I recommend getting a machine with an arm cuff, not the wrist cuff, and put the machine, try to sit down and put the machine at the same level as your heart so that you get accurate measurements."