Why high blood pressure is known as a silent killer

Blood pressure management isn’t a sexy topic like “anti-aging drugs” or “DNA-based diets,” but it has enormous implications for health and life span. And because lifestyle factors have such a profound impact, everyone has the power to take steps toward controlling and improving their BP. It’s bread-and-butter primary-care medicine—but a critical part of the longevity playbook.Video above: A doctor shares tips on how to reduce high blood pressureHigh blood pressure is a silent killer. There are no symptoms, yet over time the effects of high blood pressure can compound, elevating the risk for heart attacks and other serious health concerns, including stroke and dementia. For this reason, managing blood pressure relatively early in life is critical, but many people aren’t even aware of their BP status. Though nearly half of all adults in the United States have hypertension—defined as blood pressure with a systolic reading at or above 130 mm Hg and a diastolic reading at or above 80 mm Hg (see below)—only about one in four among this group have their condition under control.While standard medical wisdom once advised treating to a target of <140/<90, the landmark SPRINT study found that bringing BP down to <120/<80 resulted in huge reductions in the risk of heart attack, stroke, and death from all causes. So when it comes to keeping BP in check, an aggressive approach provides the most benefits—but where do we begin?Blood Pressure Categories• NORMAL: < 120 mm Hg (Systolic); < 80 mm Hg (Diastolic)• ELEVATED: 120–129 mm Hg (Systolic); < 80 mm Hg (Diastolic)• STAGE 1 HYPERTENSION: 130–139 mm Hg (Systolic); ≥ 140 mm Hg (Diastolic)• STAGE 2 HYPERTENSION: 80–89 mm Hg (Systolic); ≥ 90 mm HgThe art of measuring blood pressureTo manage your BP, you first need to know where you’re starting. While a one-time measurement might provide a rough estimate, blood pressure is subject to acute fluctuations based on hydration, stress level, posture, caffeine intake, sleep deprivation, and other variables, so a more accurate picture requires multiple measurements over a span of days. I advise patients to use a home device to check their BP twice a day, at the same time each morning and evening, for at least two weeks. The average of those readings will provide a much more accurate reference value than any one-time check. From there, you can monitor changes with weekly or even monthly checks, each time taking one measurement in the morning and one in the evening. The goal of checking frequently is to recognize increases as quickly as possible to facilitate faster intervention.The gold standard for measuring BP is with a cuff and stethoscope, but this manual method can be intimidating to learn. In my experience, automated cuffs can overestimate BP because they work on an algorithm that estimates systolic and diastolic blood pressure from a measured “mean arterial pressure” (average BP, essentially), but they are generally good alternatives. I’ve used both the Withings (withings.com; BPM Connect, $130) and Omron (amazon.com; M3 model, $80) brand cuffs. Accuracy essentialsBecause so many variables affect BP, it’s important to follow the same protocol for every measurement: • Sit with your back supported for five minutes before measuring. (This can feel like a long time since you should not be looking at your phone or speaking.)• Do not cross your legs.• Check that the cuff is against your skin and fits well. • Avoid talking during the check.Note: Having a full bladder can bump up your BP by 10 to 15 mm Hg.This story appears in the November 2023 issue of Men's Health.