Hypertension: A Silent Threat to Health

By the time someone reaches 40, over half of Americans have high blood pressure, often without realizing it. Dubbed the silent killer, hypertension can be lethal if untreated. It typically goes unnoticed because most individuals don’t feel any different as their blood pressure rises.

Recent guidelines from the American Heart Association emphasize the importance of early intervention. This includes making lifestyle adjustments and possibly using medications once systolic blood pressure exceeds 130/80 mm Hg. Experts suggest that taking measures sooner rather than later can significantly boost one’s health.

Hypertension remains a prime contributor to heart disease, which is the leading cause of death for both genders in the U.S. It also raises the chances of kidney disease and dementia. Notably, research shows that high blood pressure can damage small blood vessels in the brain, which is linked to cognitive decline.

“We have a vast opportunity to prevent health issues by addressing hypertension earlier,” notes Dr. Jordana Cohen, a specialist in nephrology and hypertension. It seems many adults could gain from medications and better lifestyle choices.

“If you detect it early and manage it promptly, you can enjoy significantly more healthy years,” Cohen explains, highlighting a lowered risk for heart attacks, strokes, kidney problems, and dementia.

The latest guidelines reaffirm long-standing advice promoting a low-sodium diet, even though sticking to it can be tough, especially since more than half of the calories Americans consume come from ultra-processed foods, which are often high in salt.

The new recommendations also focus on lifestyle changes like exercising, reducing alcohol intake, and managing stress through methods such as meditation or yoga. For those with systolic blood pressure in the 130s, starting with these lifestyle changes is preferred, progressing to medications if necessary.

Individuals reaching a systolic blood pressure of 140 or above—classified as stage 2 hypertension—should consider starting medications right away. According to Dr. Dan Jones, chair of the guideline writing committee at the Heart Association, “We advise beginning treatment with two medications for anyone with a blood pressure reading above 140/90 mm Hg.” He mentions that relying on one medication alone often falls short of achieving the desired blood pressure levels.

Interestingly, even among those recognized as having hypertension, over half still struggle to lower their blood pressure to the normal range of 120/80 mm Hg or below. This might be due to various factors—side effects from medications, individual variations in responsiveness, or some people’s reluctance to take medication. Additionally, many find it challenging to change their everyday habits. Jones emphasizes the value of using a risk calculator to evaluate a person’s chances of heart disease, helping tailor treatment plans.

George Solomon had been hesitant about medication when first informed of the dangers of high blood pressure. “I felt fine,” he remarked. Yet at age 63, he experienced a stroke.

After retiring from law enforcement, he was adjusting to a more relaxed lifestyle, squeezing in exercise and hobbies like splitting wood on his farm. In the spring of 2023, an unsettling feeling struck him.

“I went upstairs to watch TV, and when I sat down, I couldn’t get back up. Something came over my back, and I lost feeling in my arm and leg,” he recalled. An ambulance rushed him to Duke University Hospital, where he received treatment and rehabilitation for his stroke.

Now, Solomon estimates he’s about 80% recovered and has returned to exercising and working on his farm. He is more aware that a healthy lifestyle is crucial, along with medications, to prevent another stroke.

“I think I’m on the right track,” he states, having lost weight and incorporating more cardio and strength training into his routine. He hopes that by sharing his experience, others feel motivated to take action.

Medications: What’s Available and What’s Upcoming

There’s a range of medications for treating hypertension: diuretics to eliminate excess salt and water, ACE inhibitors to block the production of a hormone called angiotensin II (which relaxes blood vessels), and calcium channel blockers that regulate calcium movement in cells to lower blood pressure.

However, many individuals with hypertension aren’t getting sufficient results from existing medications. Dr. Cohen mentions that there’s growing interest in a new class of drugs targeting the hormone aldosterone, which plays a role in fluid and sodium regulation in the body. Excessive levels of this hormone contribute to high blood pressure, and while the drug isn’t available yet, promising study results could introduce a new option for treatment.

“In the realm of hypertension, we haven’t seen significant innovations since the nineties,” Cohen shares. Thus, additional treatment options could be highly beneficial.

A study published in the New England Journal of Medicine demonstrated that the aldosterone-blocking medication, baxdrostat, effectively reduced blood pressure for many who struggle to control their condition.

Involving around 800 individuals who hadn’t been able to lower their blood pressure to normal—even while taking two to three medications—the results showed a notable improvement. “After 12 weeks, we observed approximately a ten-point drop in blood pressure among those treated with baxdrostat compared to the placebo group,” explained Dr. Jennifer Brown, a cardiologist involved in the study. Astra Zeneca, the drug’s maker, plans to submit its data to regulatory authorities soon.

A decrease of ten points in systolic blood pressure correlates with around a 20% reduction in the chances of heart attacks and strokes, as well as a lower risk of dementia.