By the age of 40, more than half of Americans are affected by high blood pressure, yet many remain unaware of their condition. Hypertension, often referred to as the silent killer, poses significant health risks if left untreated. Its subtlety lies in the fact that most individuals do not exhibit any symptoms; the increasing pressure within blood vessels goes unnoticed. According to new recommendations from the American Heart Association, early intervention is crucial. The guidelines suggest initiating treatment, which includes lifestyle modifications and medications, once systolic blood pressure exceeds 130/80 mm Hg (a measurement of pressure in millimeters of mercury).
Experts agree that taking action at the earliest signs of hypertension can significantly enhance one's health outcomes. Hypertension is a leading contributor to heart disease, the foremost cause of death among both men and women in the United States. Additionally, high blood pressure heightens the risk of developing kidney disease and dementia. Research indicates that hypertension can also cause damage to small blood vessels in the brain, leading to cognitive decline. Dr. Jordana Cohen, a nephrologist and hypertension specialist at the University of Pennsylvania, emphasizes the substantial preventive health opportunity that lies in early treatment of hypertension. “If you catch it early and treat it early, you can enjoy many more years of healthy life expectancy,” she notes, highlighting the reduced risk of severe health issues like heart attacks, strokes, and dementia.
The new guidelines reiterate the longstanding advice about the advantages of a low-sodium diet. However, adhering to this recommendation can be challenging, as over half of the calories consumed in the U.S. originate from ultra-processed foods, which are typically high in salt. The guidelines also stress the importance of adopting lifestyle strategies, including increasing physical activity, limiting alcohol intake, and practicing stress-reduction techniques such as meditation, yoga, or deep breathing exercises.
For individuals with systolic blood pressure in the 130s, the guidelines recommend starting with dietary and lifestyle changes before considering medication if blood pressure levels do not improve. For those whose systolic blood pressure reaches 140 or higher, classified as stage 2 hypertension, evidence supports the immediate initiation of high blood pressure medications. Dr. Dan Jones, chair of the guideline writing committee at the Heart Association, advises that individuals with blood pressure over 140/90 mm Hg should begin treatment with two medications, as research shows that one medication alone is often insufficient to achieve optimal blood pressure levels.
Despite awareness of their condition, over half of individuals diagnosed with hypertension struggle to lower their blood pressure to the normal range of 120/80 mm Hg or below. Challenges include medication side effects, variability in individual responses to treatment, and a reluctance to take prescribed medications. Moreover, many face everyday obstacles when it comes to implementing lifestyle changes.
Healthcare providers often utilize a risk calculator to assess an individual's risk of heart disease as part of a comprehensive treatment plan. George Solomon, who was initially hesitant to take medications, learned the hard way about the risks associated with high blood pressure when he suffered a stroke at age 63. After experiencing a sudden health crisis, he recognized the importance of maintaining healthy lifestyle habits alongside medication to prevent future strokes. Solomon has since adopted a healthier routine, including weight loss and increased cardio and strength training, sharing his story to encourage others to take proactive steps towards managing their hypertension.
Various medications are available for treating hypertension, including diuretics that help eliminate excess salt and water from the body, ACE inhibitors that block the production of the hormone angiotensin II to relax blood vessels, and calcium channel blockers that slow calcium movement into cells to lower pressure. However, many patients do not achieve adequate blood pressure reduction with existing medications. Dr. Cohen highlights the growing interest in new classes of medications targeting the hormone aldosterone, which regulates fluid and sodium levels in the body — an excess of which can contribute to high blood pressure.
Although a new aldosterone-blocking drug known as baxdrostat is not yet available on the market, recent studies suggest it could offer a promising treatment option. A study published in the New England Journal of Medicine demonstrated that baxdrostat effectively lowered blood pressure in individuals who struggled to manage their hypertension despite being on multiple medications. The study included around 800 participants, and results showed an approximate ten-point improvement in blood pressure after 12 weeks of treatment with baxdrostat compared to a placebo. Dr. Jennifer Brown, a cardiologist involved in the research, noted the potential for this new drug to be a valuable addition to hypertension treatment options, especially since advancements in effective treatments have been scarce since the 1990s.
