Dr. Richard Mallo-Escondido
Richard Mallo, MD

Note: This article has been updated to reflect new ACC/AHA guidelines effective November 2017 regarding the definition of hypertension.

This month’s guest author, Dr. Richard Mallo, is a board certified Internal Medicine physician in Graybill’s Escondido Second Avenue Office. Dr. Mallo treats the full range of adult health concerns, including high blood pressure.

When was the last time you had your blood pressure checked? If you can’t remember, then it’s probably time to make an appointment with your primary care doctor. Why? Because you may have high blood pressure and not even know it. And having uncontrolled high blood pressure can be dangerous.

U.S. hypertension statistics
1 in 3 American adults have high blood pressure; many don’t know they have it.

Uncontrolled high blood pressure places you at a high risk for a number of catastrophic health events. It’s present in 70% of people who have their first heart attack, 80% of people who have their first stroke, and 75% of people who have congestive heart failure. In fact, hypertension is one of the most common chronic health conditions among adults in the United States.1

  • 75 million (one in three) adults have high blood pressure
  • 14 million (one in five) don’t know they have it
  • 37 million (half) do not have it under control
  • About 75 million (one in three) adults have “pre-hypertension,” meaning that they are likely to develop high blood pressure

What is high blood pressure?

Blood makes it possible for our cells to function, generate energy, grow tissues, and fight disease. Blood is delivered to every cell in our body through the cardiovascular system that consists of our heart, arteries, capillaries and veins.

Blood pressure is the measurement of force of each heartbeat against major blood vessels called arteries. It is measured in millimeters of mercury (mmHg) and includes systolic pressure (the pressure in your arteries when your heart beats) and diastolic pressure (the pressure in your arteries between heartbeats). The medical term for high blood pressure is hypertension.

Depending on your individual blood pressure you will fall into one of the following categories:2

Category Systolic (top number)   Diastolic (bottom number)
Normal Less than 120 and Less than 80
Elevated 120-129 and Less than 80
Hypertension – Stage 1 130-139 or 80-89
Hypertension – Stage 2 140 or higher or 90 or higher
Hypertensive Crisis* 180 or higher and/or 120 or higher

*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.

Keep in mind that a single high reading doesn’t necessarily indicate that you have high blood pressure. Your blood pressure can vary throughout the day. It will be lower when you’re asleep and when you wake up. It can rise if you’re nervous, active or under stress. In addition, certain drugs such as painkillers, nasal decongestants and some prescriptions can raise your blood pressure.

If your primary care physician suspects you have high blood pressure, he or she will take several readings over time or ask you to monitor it at home for several days before making a formal diagnosis of high blood pressure.

Risk factors for high blood pressure

hypertension risk factorsHigh blood pressure can affect men and women of all ages and ethnic backgrounds. However, the following factors can increase your risk to develop hypertension. 3

Factors you can’t control:

  • Family history. High blood pressure runs in families. Families with a history of heart attack, stroke, diabetes, kidney disease or high cholesterol usually have a high risk of developing high blood pressure.
  • Age. The risk of developing high blood pressure increases with age. About two-thirds of people in the U.S. who are over age 65 have high blood pressure.
  • Gender. Up to age 45 more men than women have high blood pressure. From 46 to 54 men and women seem to be affected equally. After age 55, a more women have high blood pressure than men.
  • Race. African Americans are 40% more likely to have high blood pressure than Caucasians.

Factors you can control:

  • High salt/sodium intake. A diet high in salt and sodium has been directly linked with high blood pressure. A decrease in salt consumption has been shown to improve blood pressure.
  • Excess weight. People who are overweight are three times more likely to develop high blood pressure. For people who are obese, the risk is even higher.
  • Unhealthy lifestyle. Smoking, heavy drinking and a sedentary lifestyle (low physical activity) are all recognized contributors to high blood pressure.

The “silent killer”

high blood pressurePart of the danger of having hypertension is that it has no symptoms. Even if you can’t “feel” it, hypertension places a stress on your entire circulatory system. Over time, your heart and arteries can become less effective at pumping blood to organs that depend on a nourishing blood supply, such as your kidneys, eyes, and brain.

High blood pressure is often referred to as a “silent killer” because many people don’t realize they have it until they develop a serious condition. It’s been identified as a contributing factor in many serious health conditions, including:

  • Heart failure
  • Heart attacks
  • Strokes
  • Kidney failure
  • Loss of vision
  • Hardening of the arteries
  • Dementia

How to lower your risk of high blood pressure and complications

healthy dietThe good news is, high blood pressure can be easily detected and it is both preventable and treatable. To protect yourself from the dangers and complications of high blood pressure:

  1. Get regular checkups. Your doctor will measure your blood pressure, pulse, and other “vitals” during your physical exam. Be sure to ask your provider what your blood pressure is and ask about any risk factors you have and possible ways to prevent or manage it.
  2. Lower your salt/sodium intake. Americans consume an average of one-and-a-half teaspoons of salt (the equivalent of 3400 mg of sodium) every day. This is more than double the 1500 mg of sodium per day the American Heart Association considers to be a “healthy level.” Fast foods and processed foods tend to be high in sodium, so be sure to read labels before you buy. Better yet, avoid processed foods as much as possible and opt for more fresh vegetables and fruits.
  3. Make healthy lifestyle changes. Eating a healthier diet with more vegetables and fruits, getting regular exercise, reducing stress, consuming less alcohol and quitting smoking have all been shown to promote healthier blood pressure and improve cardiovascular health. Even small changes like switching to low-sodium foods, climbing the stairs instead of taking the elevator can or meditating for five minutes a day can make a big difference in your health.
  4. Take your medication as directed. If lifestyle changes aren’t enough, your doctor may prescribe medication to control your blood pressure. If you are on medication be sure to continue taking it even if you “feel better.” Remember that high blood pressure has no symptoms and controlling it with medication doesn’t mean you don’t have it.

Awareness is the key to avoiding the dangers of high blood pressure. You can steer clear of the complications associated with hypertension by staying informed, adopting healthier lifestyle changes, and working with your health care provider.


  1. U.S. Centers for Disease Control and Prevention, “High Blood Pressure Facts.” Available at https://www.cdc.gov/bloodpressure/facts.htm. Retrieved 12/2/19.
  2. Journal of the American College of Cardiology, “New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension”. Available at https://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017. Retrieved 12/2/19.
  3. American Heart Association. “Know Your Risk Factors for High Blood Pressure.” Available at https://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandSymptomsRisks/Know-Your-Risk-Factors-for-High-Blood-Pressure_UCM_002052_Article.jsp. Retrieved 2/9/17.