How Bad Is it to Ignore High Blood Pressure?

Hypertension is a symptomless condition.
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The Scenario
Your buddy seems to do everything right: He eats reasonably healthy, works out five days a week, and it shows. He's fit, full of energy, and never seems to take a sick day. But last week, while waiting for a new passport photo at CVS, an eager salesperson swindled him into throwing on a blood pressure cuff. The numbers showed 130/80—a bit higher than that 120/80 goal ingrained in most of our brains. What gives? And is he now screwed if he doesn't add, say, yoga and meditation to his weekly routine?


The Facts
For the first time in 14 years, The American Heart Association and American College of Cardiology recently tweaked the script on what qualifies as high blood pressure: Instead of a 140/90 reading (the top number, systolic pressure, is a measure of the force of pressure against your artery walls as the heart contracts to pump blood to the rest of the body; the bottom number, diastolic pressure, is your blood pressure between heart beats), hypertension now starts at 130/80. The news comes after a 2015 study in the New England Journal of Medicine found that those who aim to get their blood pressure below 120/80, as opposed to below 140/90, had a 25 percent lower risk of heart attack, stroke, or cardiovascular death. Here’s the issue: Under these new, stricter guidelines, the prevalence of high blood pressure is set to triple among guys under 45 (including your friend, who is now in the red zone) and double in women under 45—many who don’t know it. Because hypertension is a symptomless condition, only around half of adults with high blood pressure have it under control.

The Worst That Can Happen
If your friend’s blood pressure shoots up super high (or he starts dealing with other cardiovascular risk factors, like if he takes up smoking, gains a lot of weight, or has Type 2 diabetes) his arteries could become so damaged that blood flow to the heart becomes blocked, triggering a heart attack. (Yes, it's a rare event for someone in their 20s and 30s, but it does happen, says cardiologist Mary Norine Walsh, president of the American College of Cardiology.) Similarly, serious damage to the blood vessels in his brain from extreme blood pressure could trigger a stroke. And if the arteries around his kidneys become so beat up that they can’t filter blood, he could have kidney failure, leading to a lifetime of dialysis.


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What Will Probably Happen
Nothing, at least immediately. If your friend’s blood pressure lingers right at that 130/80 mark, he’ll likely feel fine for years—maybe even decades. But on the inside, his arteries will slowly and silently start to narrow and stiffen, forcing the heart to work harder to pump blood. The extra push will thicken the heart muscle over time, making it tougher for his number one organ to do its day job. Ultimately, if left untreated, high blood pressure (even if it’s just slightly elevated) will almost inevitably lead to a heart attack, stroke, heart failure, or kidney failure down the road, Walsh says. Your friend might hit 55 before it happens, but the damage is pretty much unavoidable.

What You Should Tell Your Friend
Try to chill—it’s not all bad news. High blood pressure happens to be one of easiest health conditions to fix through lifestyle changes like diet and exercise. When your friend sees a doc (and he should really, really see a doc—Walsh says we should all have our blood pressure checked annually) the physician will likely recommend trying the DASH (Dietary Approaches to Stop Hypertension) diet, which limits sodium and saturated fats and increases your intake of veggies, fruits, whole grains and fish. If he’s not already exercising regularly, adding cardio and weight lifting to his routine (both good for reducing blood pressure) is the next move, along with cutting back on alcohol (to a drink a day) and losing those extra pounds. Dropping just ten pounds can reduce your blood pressure along with your risk of heart attack and stroke. If lifestyle interventions don’t work (but in otherwise healthy, young people, odds are they will), the doc may put him on a prescription medication for high blood pressure like an ACE inhibitor, which can help prevent the narrowing of blood vessels.

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