Hypertension: What Causes High Blood Pressure and How to Treat It

Many of our doctor visits begin with a routine blood pressure reading, something you might not pay much attention to if your levels are normal.

But 48% of Americans have high blood pressure, also known as hypertension, and managing the condition is important because untreated hypertension increases the risk of stroke, vascular dementia, heart attack, and congestive heart failure, among other problems, says Erica Spatz, MD, MHS, director of the Yale Medicine Preventive Cardiovascular Health Program.

Your blood pressure takes two numbers into account: systolic and diastolic pressure. Systolic pressure is the pressure in your arteries when your heart beats; diastolic is the pressure when your heart rests between beats. A normal blood pressure is 120 (systolic) over 80 (diastolic), or 120/80. Hypertension is defined as blood pressure that is consistently 130/80 or higher, meaning the systolic pressure is 130 or higher and the diastolic pressure is 80 or higher.

High blood pressure increases in prevalence with age, and genetics also play a role, Dr. Spatz says. Other factors that contribute to hypertension include sleep, stress, diet, physical activity, and psychological factors, such as a history of depression or anxiety, loneliness, and discrimination, adds Allison Gaffey, PhD, a Yale Medicine psychologist who specializes in cardiology. Over time, chronic stress can elevate your hormone levels, including the hormone cortisol, which raises blood pressure, Gaffey explains.

To treat hypertension, Yale Medicine providers review a patient’s diet, sleep, activity levels, and stress management techniques and recommend changes that may help lower their blood pressure. If those adjustments are not enough, then medication is considered, Dr. Spatz says.

But the first step is getting patients to seek care. Because Black Americans develop high blood pressure more often and earlier in life than whites, Hispanics, and other groups, Yale Medicine strives to have a diverse care team and partners with community organizations to connect young Black men with services. Sometimes, logistics like transportation or work schedules can make it hard for someone to get to the doctor for checkups. Digital tools, including home blood pressure monitoring, are one way to address such barriers.

“We have remote blood pressure management programs where we give everyone a home blood pressure cuff and a mechanism to transmit that data into our health system, so we can provide a centralized blood pressure management team that can reach out to them on a weekly basis and form a therapeutic plan,” Dr. Spatz says.

In the video above, Yale Medicine providers discuss hypertension and efforts to address the condition with outreach and technology.