“I Feel Fine. Why Do I Have to Take Pills for High Blood Pressure?”

I hear this question frequently in my daily practice of cardiology, and the answer is simple: High blood pressure is frequently symptomless, a silent killer. Although 1 in 3 Americans have high blood pressure (about 68 million) only about 1 in 5 (20.4 percent) know they have it.

High blood pressure is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease. It is a direct cause of death for more than 25,000 people a year and, as a related cause of death for more than 300,000.

Despite these impressive statistics, only 7 in 10 Americans with high blood pressure are on any medications at all, and only 50 percent of those on medications are under adequate control. High blood pressure costs the United States more than $95 billion per year in direct healthcare service costs, medications, and missed days of work.

What is “End-Organ Effect?”

Although you may not have symptoms now, over time, untreated high blood pressure will cause symptoms by something called “end-organ effect.” That’s the effect high blood pressure has on vital organs, such as the brain, heart, and kidneys.

For example, a patient with severe high blood pressure may be relatively free of symptoms when younger but, over time, have a high blood pressure-related stroke (end-organ is the brain in this example) with symptoms of weakness, paralysis, visual disturbance, and inability to reason or speak.

Chest pain, shortness of breath, and leg and abdominal swelling may be signs of high blood pressure’s end-organ effect on the heart and/or kidneys. Once these end-organ effects occur, there is often significant and irreversible damage.

Why Early Detection and Treatment Are Important

The need to detect and treat high blood pressure in its early stages is clear—even if you feel good. Sometimes, a patient will stop high blood pressure medications because the blood pressure has come under good control. This is a mistake because the medications themselves are the reason for the good control and need to be taken as directed.

A reasonable reduction in salt intake is also helpful in controlling high blood pressure. Simply avoiding the salt shaker and high salt-containing foods is a genuine help in controlling this disease process.

Who is at Risk for High Blood Pressure?

Overall, women and men have about the same likelihood of developing high blood pressure. For people under age 45, men are more at risk, while women in the over 45 age group are more likely to develop the condition. A family history of high blood pressure, stroke or heart attack should prompt even a young individual to have his or her blood pressure checked and followed.

The bottom line is everyone is a potential candidate for high blood pressure, and it’s vitally important to have your blood pressure checked at your family doctor’s office. If there’s any question of high blood pressure, a good approach is to purchase a simple, digital blood pressure cuff and record your blood pressure several times a week at the same time of day.