Understanding the “silent killer” 

High blood pressure, also called hypertension, is a condition in which the force of the blood against blood vessels is consistently too high. Approximately every 1 in 3 American adults have high blood pressure, but many do not even know they have it.  

People often refer to high blood pressure as the “silent killer” because it usually doesn’t cause obvious symptoms. However, when left untreated, high blood pressure damages the delicate tissue in the circulatory system, which can lead to heart attacks, heart failure, stroke, vision loss, kidney disease, sexual dysfunction, and many other serious conditions. That’s why it is important to have your blood pressure measured regularly, and work with your doctor to control it if you have high blood pressure.   

Understand the numbers   

A blood pressure reading is measured in mmHg (millimeters of mercury) and has two numbers:  

  • Systolic Pressure (the first/upper, number): measures the pressure in arteries when the heart beats. 
  • Diastolic Pressure (the second/lower number): measures the pressure in arteries when the heart rests between beats.  

Normal systolic and diastolic blood pressures

The American Heart Association categorizes blood pressure into five ranges. 

  • Normal: 120/80 or lower. People with blood pressure in this category should continue healthy habits such as having a balanced diet that’s low in salt and staying physically active.  
  • Elevated: 120-129 in systolic and less than 80 in diastolic. People with elevated blood pressure need to take action, otherwise they will likely develop high blood pressure.  
  • Hypertension Stage 1:130-139 systolic or 80-89 diastolic. In addition to lifestyle changes, doctors are likely to prescribe blood pressure medication(s) for people with hypertension stage 1.
  • Hypertension Stage 2: 140/90 or higher. People with this stage of high blood pressure are likely be prescribed a combination of blood pressure medications and lifestyle changes.  
  • Hypertension crisis: 180/120 or higher. People at this stage of high blood pressure requires immediate medical attention because such high blood pressure can lead to a heart attack, stroke, or other life-threatening health problems.  

These numbers matter: studies show every 20 mm Hg of systolic or 10 mm Hg of diastolic increase in blood pressure doubles the risk of death from ischemic heart disease and stroke.  


What’s the right way to measure blood pressure?  

All people with high blood pressure should monitor blood at home. This helps the health care provider determine whether your treatment is working. Even if your blood pressure reading is within normal range, you should continue to take the medication prescribed by your doctor to keep the blood pressure under control. Here is how to use a home blood pressure monitor: 

  • Be still: For 30 minutes before blood pressure measurement, do not smoke, drink caffeinated beverage, or exercise. Before starting, ensure you have emptied your bladder, sit quietly in a comfortable position, and rest for 5 minutes.  
  • Sit correctly: Sit in a chair with legs uncrossed, feet flat on the floor, back straight and supported, arm supported on a flat surface, like a dining table. Put the blood pressure cuff on the bare arm and above the elbow. Make sure to position the arm, so the cuff is at heart level.  
  • Measure at the same time every day: Take the reading at the same time each day before taking daily blood pressure medication.  
  • Take multiple readings and record the results: Take two or three measurements one minute apart. And record measurements on a daily tracker and take them to your next doctor appointment.  
  • Bring your monitor yearly to doctor appointments: Your health care provider can check if your monitor is working properly and that it gives accurate readings.  


What do I do when I get a high blood pressure reading? 

Blood pressure fluctuates, if you get a single reading that is slightly or moderately higher than normal, do not be alarmed. Wait a minute and take your blood pressure at least one more time, following the instruction to measure blood pressure accurately. If the reading remains higher than normal for a few days, call your doctor’s office to determine if there is a health concern.     

If your blood pressure is 180/120 or greater and you are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, headache, nausea and vomiting, blurred vision, or difficulty speaking, this is considered a Hypertensive Emergency. Do not wait to see if your blood pressure will come down. You or someone next to you should call 911 immediately. 

If your blood pressure exceeds 180/120, but you are not experiencing any symptoms, wait 5 minutes and measure it again. If the reading remains high, you could have Hypertensive Urgency and should call your doctor immediately. Your healthcare provider will give your instructions on what to do.  

How to manage high blood pressure 

Working with your doctor and taking blood pressure medications properly are vital to lowering your blood pressure. But the treatment is not complete without lifestyle changes, which include eating a balanced diet, using less salt (sodium) in food, increasing physical activity, maintaining a healthy weight, limiting alcohol, quitting smoking, and managing stress. Adapting healthy habits might seem daunting, but each small step counts! Starting with simple and small changes that you can stick with is the key to set you up for success, and you should always seek support from your health care team, family, and friends.  


Prepared by Wenye Dang PharmD



American Heart Association | High Blood Pressure 

FDA | High Blood Pressure-Understanding the Silent Killer  

Mayo Clinic | Elevated Blood Pressure