High Blood Pressure—The Silent Killer

What if there were a disease that was almost impossible to detect until you became seriously ill? And what if that same disease could be easily controlled once diagnosed? In a nutshell, that's high blood pressure — no symptoms, possibly deadly, and yet controllable.

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Why does the CDC call high blood pressure the silent killer?

Here's an eye-opening fact: according to a Northwestern University study, deaths in the US from high blood pressure increased by 0.5% each year between 2000 and 2018. In 2019, hypertension was the primary or contributing cause of death in over 516,955 people.

There are very few outward signs of high blood pressure. Most people don't even realize they have it until they see their doctor for a yearly physical check or another condition. If they’re not having regular doctor’s visits, some don’t know they have hypertension until they develop complications.

How many Americans have high blood pressure?

Millions of Americans are walking around with high blood pressure — almost a third of the population, more than 100 million people.

What's even scarier is that because of the obesity epidemic in the US, children are also at risk for high blood pressure. According to the Cleveland Clinic, about 3.5% of children under 18 have been diagnosed with high blood pressure, but because the symptoms are so hard to recognize, doctors believe the actual number is higher.

There are also millions of Americans with undiagnosed hypertension; recent data indicates that more than 14 million people in the US don't know that they have high blood pressure.

Only about 25% of adults diagnosed with high blood pressure are taking prescribed medication.

Who is most at risk of high blood pressure?

Risk factors for hypertension fall into two broad categories: genetics and lifestyle.



In the US, Black people are more prone to developing high blood pressure than other racial groups, and it happens earlier in life.


Until you’re 40, the chance that you’ll have high blood pressure is about 7.5%. The risk increases with age; by the time you’re 60, the prevalence goes up to 63.1%.


Men have higher rates of hypertension compared to women up to the age of 60 years, when women quickly surpass them, likely due to the effects of menopause.

Family history

High blood pressure runs in families. If you have a family history, let your doctor know so they can be on the lookout for changes in your numbers.



If you have a lot of stress in your life, your blood pressure is likely to increase. It may be temporary, but stress is a risk factor. Unfortunately, unhealthy coping methods like smoking, drinking, and binge eating only make the situation worse.


There are many reasons why being overweight is unhealthy, such as hormonal imbalances and chronic inflammation, but the risk of high blood pressure plays a definitive role.

Your body depends on your blood to deliver oxygen and other nutrients throughout your tissues, and the heavier you are, the more blood it takes to get the job done.

Increased blood flow puts greater pressure on your artery walls, which causes them to become thicker and more resistant to the blood flowing through them, increasing the risk of hypertension.

Sedentary lifestyle

Sitting a lot contributes to many health problems such as diabetes, certain cancers, and cardiovascular disease. It has been associated with increases in both systolic and diastolic blood pressure in proportion to the amount of sedentary time.

The theory is that prolonged sitting leads to low-grade inflammation, changes in blood flow, and altered regulation of blood sugar.

For many people, physical inactivity and being overweight go hand in hand, increasing the risk even more.


The NIH recommends a form of the Dash diet to combat high blood pressure. It's an eating plan heavy on foods rich in calcium, potassium, and magnesium — minerals that help control blood pressure. The DASH diet limits foods high in saturated fats, sugar, and sodium.

Tobacco use

Any tobacco use, smoking or chewing, can raise your blood pressure and heart rate right away. It's a temporary increase, but sustained nicotine use can result in constricted arteries.

Alcohol use

The research on alcohol use and heart disease is somewhat unclear on exactly how alcohol increases blood pressure, but there is a definite link between excessive drinking and hypertension.

Research says that even moderate drinking is unhealthy, while other studies have indicated that moderate alcohol is protective. A recent review found that no amount of drinking is healthy.

What are the risks of uncontrolled high blood pressure?

The silent killer has many ways to sneak up on you and contribute to severe health problems. Since blood flow is part of the cardiovascular system, most complications result from hypertension-related effects on blood vessels and their dependent tissues and organs.

Complications that can result from uncontrolled high blood pressure include:

  • Heart attack and heart failure

  • Stroke

  • Peripheral or coronary artery disease

  • Vascular dementia

  • Aneurysm

  • Chronic kidney disease

  • Vision problems

Signs you should talk to your health care professional

If you are a breathing human, that's the sign you should speak to your doctor about high blood pressure.

Since this disease is the “silent killer,” it's up to you to recognize the risk factors and see your doctor if anything changes — if you've taken up smoking, been drinking excessively, gained weight, have more stress in your life, or if someone in your family has been diagnosed with hypertension.

One physical indicator that you need to discuss your blood pressure with your doctor is if your pants don't button. Women with a waist measurement over 35 inches and men with a measurement of 40 inches are at higher risk.

The lowdown

If there's a silver lining to high blood pressure, it's that many people can control the disease. If hypertension is part of your genetic makeup, lifestyle changes can still make a big impact, although some people will also need to take medication.

Getting high blood pressure under control is a key factor in maintaining your overall health and ensuring you don’t suffer any complications.

  1. Trends in hypertension-related cardiovascular mortality in the United States, 2000 to 2018 (2020)

  2. Facts about hypertension | Centers for Disease Control and Prevention

  3. More than 100 million Americans have high blood pressure, AHA says | American Heart Association

  4. High blood pressure in children | Cleveland Clinic

  5. Vital signs: Prevalence of key cardiovascular disease risk factors for million hearts 2022 — United States, 2011–2016 (2018)

  6. Know your risk for high blood pressure | Centers for Disease Control and Prevention

  7. Hypertension prevalence and control among adults: United States, 2015–2016 | Centers for Disease Control and Prevention

  8. Hypertension prevalence and control among adults: United States, 2015–2016 (PDF copy) | Centers for Disease Control and Prevention

  9. Obesity-induced hypertension (2015)

  10. Sitting less and moving more (2018)

  11. Sedentary behavior and blood pressure control among osteoarthritis initiative participants (2015)

  12. Effects of the modified DASH diet on adults with elevated blood pressure or hypertension: A systematic review and meta-analysis (2021)

  13. Cardiovascular toxicity of nicotine: Implications for electronic cigarette use (2017)

  14. Hypertension and alcohol: A mechanistic approach (2020)

  15. Study suggests moderate drinking harms not protects heart health | American College of Cardiology

  16. No level of alcohol consumption improves health (2018)

  17. Waist circumference change is associated with blood pressure change independent of BMI change (2020)

  18. Your guide to lowering blood pressure (2003)

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