Hypertension in the General Population

By Sharon Lewis

Taber’s Cyclopedic Medical Dictionary defines Hypertension as greater than normal tension or tone; in adults, a condition in which the blood pressure (BP) is higher than 120 mm Hg (millimeters of mercury) systolic or 80 mm Hg diastolic on three separate readings recorded several weeks apart. (Taber’s Cyclopedic Medical Dictionary, 23rd Edition)

Blood pressure is the force exerted by the blood against a vessel wall (artery). The maintenance of proper blood pressure is crucial for the health and proper functioning of the body. To measure your blood pressure, your doctor uses an instrument called a sphygmomanometer. It is connected to an inflatable cuff and wrapped around the upper arm. The cuff can also be wrapped around the lower arm if the arm is too big for the cuff. A stethoscope is then placed at the brachial artery to listen for the “heart sound.” So, your blood pressure is given to you in two numbers. The top number is the measure of the highest pressure exerted when the two bottom chambers of the heart contract (systolic), and the bottom number is when the two bottom chambers of the heart relax (diastolic). (Thompson, 2020)

“When your blood pressure is higher than normal, it is called Hypertension. Hypertension is a significant risk factor for heart disease, the chief risk factor for stroke and heart failure, and a cause for kidney damage. (Gale Sloan Thompson, 2020) Hypertension can also cause vision loss, sexual dysfunction (erectile dysfunction in men and low libido in women), Angina (chest pain from heart disease), and Peripheral Artery Disease (PAD) (narrowed arteries in the arms and legs). (CDC, 2020) Studies have shown that the risk of death from heart disease and stroke begins at a pressure as low as 115 over 75. The risk then doubles for each 10- or 20-mm Hg increase above that. (American Medical Group Foundation, 2020) In 2014, high blood pressure was the primary or contributing cause of death for more than 410,000 Americans.” (Gale Sloan Thompson, 2020) In 2017 the American College of Cardiology and the American Heart Association issued new guidelines for high blood pressure, lowering the definition of Hypertension from 140/80 mm Hg to 120/80 mm Hg.

(Gale Sloan Thompson, 2020)

Ranges for Blood Pressure
Normal Less than 120/80 mm Hg
Elevated Systolic between 120-129 and diastolic less than 80 mm Hg
Stage 1 Hypertension Systolic between 130-139 and diastolic between 80-89 mm Hg
Stage 2 Hypertension Systolic at least 140 or diastolic at least 90 mm Hg

“High blood pressure affects everyone, but age, gender, race, or ethnicity may cause some people to be more at risk for the disease than others.

 African American Adults

As the chart below shows, the condition is seen more often among African American adults than among White and Mexican American adults.” (HHS.gov, 2020)

(American Medical Group Foundation, 2020)

 

When comparing Caucasian, Hispanic American, and African Americans; African Americans:

  • Tend to get high blood pressure earlier in life
  • Often have more severe high blood pressure and are more likely to be aware that they have high blood pressure and to get treatment
  • They are less likely to achieve target control levels with high blood pressure treatment than Caucasians
  • Have higher rates of early death from high blood pressure-related problems, such as coronary heart disease, stroke, and kidney failure than Caucasians

Hispanic American Adults

Among Hispanic American adults, high blood pressure risks vary by group. For instance, Puerto Rican American adults have higher rates of high blood pressure-related death than all other Hispanic groups and Caucasians. However, Cuban Americans have lower rates of high blood pressure-related deaths than Caucasians.

Asian Americans and Pacific Islanders

Asian Americans and Pacific Islanders have among the lowest rates of high blood pressure, at 9.7% for men and 8.4% for women.

(American Medical Group Foundation, 2020)

Native Americans/Alaska Natives

 Native Americans and Alaska Natives have rates comparable to the Mexican American population. (HHS.gov, 2020) These rates are lower than both the White and African American populations.

Age-adjusted percentage of persons 18 years of age and over who have high blood pressure, 2018
American Indian/Alaska Native Non-Hispanic White American Indian/Alaska Native

 /Non-Hispanic White Ratio

27.2 24.0 1.1

(HHS.gov, 2020)

 

Rates of High Blood Pressure Control Vary by Sex and Race

Uncontrolled high blood pressure is common; however, certain groups of people are more likely to control their high blood pressure than others. A greater percentage of men (47%) have high blood pressure than women (43%). High blood pressure is more common in non-Hispanic black adults (54%) than in non-Hispanic white adults (46%), non-Hispanic Asian adults (39%), or Hispanic adults (36%).

Among those recommended to take blood pressure medication, blood pressure control is higher among non-Hispanic white adults (32%) than in non-Hispanic black adults (25%), non-Hispanic Asian adults (19%), or Hispanic adults (25%).

Rates of High Blood Pressure Vary by Geography

High blood pressure is more common in some areas of the United States than in others. Below is a map showing Hypertension’s self-reported rate by the state in 2017 (using a definition of Hypertension as a blood pressure ≥140/≥90 mm Hg). However, the map below likely underreports the real effects of Hypertension in each state because about 1 in 5 adults with high blood pressure is unaware of it and would not report having it.

(Centers for Disease Control and Prevention, 2020)

 

Five surprising facts about Hypertension

  1. High blood pressure is linked to dementia.

Recent studies have shown that there is a link between high blood pressure and dementia, which is a loss of cognitive function that comes with aging. The onset of Hypertension during middle life (age 44-66) appears to be linked to dementia later in life. This study shows that it is never too early to start thinking about your blood pressure or taking the necessary steps to manage your blood pressure and overall health.

  1. Young people can have high blood pressure, too.

High blood pressure can occur at any age. Currently, nearly 1 in 4 young adults aged 20 – 44 have high blood pressure. It is the leading cause of stroke, which is on the rise among younger people. The experts believe that the increased risk for stroke in this age group is a direct result of the rising rates of obesity, high blood pressure, and type 2 diabetes.  All of which are treatable and preventable.

  1. High Blood Pressure Usually Has No Symptoms

Because high blood pressure usually has no symptoms, it is often called a “silent killer.” Most people with this condition feel fine. They do not even know that they need to have their blood pressure checked.

  1. Many People with High Blood Pressure are Unaware

The statistics say that 1 in 3 U.S. adults with high blood pressure are not even aware they have it and therefore not receiving treatment. Next time you visit your doctor, ask him/her what your blood pressure is and what the numbers mean.  If you are prescribed medication, take it as prescribed for the best results.

  1. Women and African Americans Face Unique Risks

Pregnant women with high blood pressure are more likely to have complications during their pregnancies than those with normal blood pressure. The condition can harm the mother’s kidneys and other organs.  It can also lead to premature delivery and low birthweights.

 

Some types of birth control can raise a woman’s risk for high blood pressure. A woman with high blood pressure that wants to become pregnant should work with their health care provider to lower their blood pressure before becoming pregnant.

African American men and women have the highest blood pressure rates of any other racial or ethnic group and are more likely to be hospitalized for the condition. Many experts believe that this group’s high blood pressure rates are tied to higher rates of obesity and diabetes. (Centers for Disease Control and Prevention, 2020)

The key to maintaining or improving one’s health is living a healthy lifestyle which includes:

  • Eating a healthy diet
  • Maintaining a healthy weight
  • Getting enough physical activity
  • Not smoking
  • Limiting alcohol consumption
  • Reducing sodium consumption
  • Being physically active
  • Reducing stress (Centers for Disease Control and Prevention, 2020)

Know that it is never too late or too early to start living healthy.

 

American Medical Group Foundation. (2020, December 12). Measure Up Pressure Down. Retrieved from Health Disparities and High Blood Pressure: http://www.measureuppressuredown.com/Learn/healthAndHighBP_learn.asp

Centers for Disease Control and Prevention. (2020, December 20). High Blood Pressure. Retrieved from 5 Surprising Facts About High Blood Pressure: https://www.cdc.gov/bloodpressure/5_surprising_facts.htm

Centers for Disease Control and Prevention. (2020, December 10). Hypertension Statistics and Maps. Retrieved from High Blood Pressure: https://www.cdc.gov/bloodpressure/facts.htm#:~:text=Rates%20of%20High%20Blood%20Pressure%20Vary%20by%20Geography,%2F%E2%89%A590%20mm%20Hg).

Gale Sloan Thompson, R. (2020). Understanding Anatomy and Physiology: A Visual, Auditory, Interactive Approach. Philadelphia: F.A. Davis.

HHS.gov. (2020, December 17). OMH U.S Department of Health and Human Services Office of Minority Health. Retrieved from Heart Disease in Native Americans and Alaska Natives: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=34

Taber’s Cyclopedic Medical Dictionary, 2018 Philadelphia: F.A. Davis.