Hypertension, commonly known as high blood pressure, is a condition where the force of blood pushing against the walls of your arteries is consistently too high. Often called the “silent killer” because it typically has no symptoms, this condition affects nearly half of all adults in the United States and is a leading cause of heart attacks, strokes, and other serious health problems.

Understanding the Scope of Hypertension

When we think about widespread health conditions, hypertension stands out as one of the most common yet concerning issues affecting people around the world. The numbers tell a sobering story about how prevalent this condition has become in modern society.

An estimated 1.4 billion adults aged 30 to 79 years worldwide had hypertension in 2024, representing about 33% of the population in this age range. What makes this even more alarming is that the majority of people with this condition live in low- and middle-income countries, where access to proper diagnosis and treatment may be limited.^[2]

The reality is that many people who have high blood pressure don’t even know it. Approximately 600 million adults with hypertension, which accounts for 44% of all cases, are unaware that they have the condition. This lack of awareness means these individuals are walking around with a serious health risk without taking any steps to address it.^[2]

In the United States specifically, high blood pressure affects nearly half of all adults. Among those diagnosed, about half have their blood pressure under control, meaning there’s still a significant number of people whose blood pressure remains dangerously high despite knowing about their condition.^[4]

The prevalence of hypertension increases significantly with age. Over 70% of people age 60 and older have high blood pressure. For those 75 and older, the numbers are even higher, with 81% of women and 73% of men experiencing elevated blood pressure.^[9]

There are also important differences across racial and ethnic groups. Black people have a higher rate of hypertension than any other racial or ethnic group, making it particularly important for individuals in this community to have their blood pressure checked regularly.^[9]

What Causes High Blood Pressure

Understanding what causes hypertension can help people make sense of why they developed the condition and what they might be able to do about it. For most people, there isn’t just one simple cause. Instead, hypertension develops as a result of multiple factors coming together over time.

Healthcare providers typically classify hypertension into two main types based on what’s causing it. The most common form is called primary hypertension, which means your genetics, family history, and age are the main reasons your blood pressure is high. For most people with high blood pressure, this is the type they have, and it usually develops gradually over many years.^[5]

The second type is secondary hypertension, which means there’s a specific, identifiable cause making your blood pressure high. This could be another medical condition you have, a medication you’re taking, or even an addictive substance. In these cases, treating or removing the underlying cause may help bring blood pressure back down.^[5]

High blood pressure usually develops over time because of unhealthy lifestyle choices. Not getting enough regular physical activity is a major contributor. When we don’t move our bodies enough, our cardiovascular system doesn’t stay as strong and flexible as it should be.^[4]

The foods we eat play a crucial role in blood pressure levels. Unhealthy diets that are high in saturated fat and trans fats (unhealthy fats found in many processed foods), along with low intake of fruits and vegetables, contribute to hypertension. One of the biggest dietary culprits is excessive salt consumption. When we eat too much salt, our bodies retain more fluid, which increases the volume of blood flowing through our vessels and pushes blood pressure higher.^[2]

Being overweight or having obesity (carrying excess body weight that increases health risks) also significantly increases the risk of developing high blood pressure. When you’re carrying extra weight, your heart has to work harder to pump blood and oxygen around the body, putting additional stress on the cardiovascular system.^[2]

Drinking too much alcohol and using tobacco products are other lifestyle factors that raise blood pressure. Smoking not only temporarily increases blood pressure, but the chemicals in cigarette smoke also damage your heart and blood vessels over time.^[2]

Beyond lifestyle factors, there are environmental risks as well. Air pollution has emerged as one of the most significant environmental risk factors for hypertension and related diseases.^[2]

Risk Factors for Developing Hypertension

While anyone can develop high blood pressure, certain factors put some people at higher risk than others. Understanding these risk factors can help you assess your own likelihood of developing hypertension and take preventive steps if needed.

Age is one of the most significant risk factors. High blood pressure increases with age because blood vessels commonly get stiff over time. As these vessels lose their flexibility, the amount of force needed to pump blood through them increases, which puts more pressure against artery walls and eventually weakens them.^[9]

If you have a family history of hypertension, meaning it runs in your biological family, you’re at increased risk of developing the condition yourself. This genetic component is something you can’t change, but knowing about it can motivate you to pay closer attention to other risk factors you can control.^[2]

People who already have certain other health conditions face elevated risk. If you have diabetes, you’re much more likely to also have high blood pressure. In fact, about 6 out of 10 people with diabetes also have hypertension. Kidney disease is another condition that often occurs alongside high blood pressure.^[2][17]

Your daily habits and lifestyle choices create either risk or protection. Not being physically active leaves your cardiovascular system weaker and less able to handle the demands placed on it. A high-salt diet directly impacts how much fluid your body retains, which in turn affects blood pressure. Being overweight or obese means your heart must work harder constantly, gradually damaging the cardiovascular system.^[2]

People who consume tobacco in any form, whether by smoking, vaping, or other methods, put themselves at risk. Even breathing secondhand smoke can increase your risk of cardiovascular disease. Similarly, drinking too much alcohol on a regular basis contributes to elevated blood pressure.^[2]

Mental health also plays a role that’s often overlooked. People who have depression, anxiety, stress, or post-traumatic stress disorder (a mental health condition triggered by experiencing or witnessing a traumatic event) over a long period of time may develop other health problems, including an increased heart rate and high blood pressure. Chronic stress causes your body to release hormones that tighten your blood vessels and raise your heart rate, which contributes to hypertension over time.^[17][19]

Recognizing Symptoms of High Blood Pressure

One of the most dangerous aspects of hypertension is that it typically doesn’t announce itself with obvious symptoms. This is why it’s earned the nickname “silent killer.” You could have it for years without feeling any clues that something is wrong.^[5]

Most people with hypertension don’t feel any symptoms at all. They feel perfectly fine going about their daily activities, which is why so many people are shocked when they discover they have high blood pressure during a routine medical visit. There’s often an assumption that if you feel well, you’re generally healthy, but the reality is that you can feel very well for a long time and not know you have significant high blood pressure that’s damaging your body.^[2][19]

However, when blood pressure becomes extremely high, some people may experience symptoms. Very high blood pressures can cause headaches, blurred vision, chest pain, and other concerning signs. These are warning signals that shouldn’t be ignored.^[2]

If your blood pressure reaches dangerously high levels—180/120 or higher—you may experience what’s called a hypertensive emergency (a medical crisis where blood pressure is so high it can immediately damage organs). Symptoms of this emergency situation include changes to your mental function, severe headache, chest pain, dizziness, swelling, heart palpitations (feeling like your heart is racing or pounding), peeing less than usual, seizures, or signs of stroke like sudden facial droop, slurred speech, or sudden arm or leg weakness. You may also experience vision changes, including eye pain, vision loss, or sudden blurry vision.^[5]

Because symptoms are usually absent until blood pressure reaches dangerous levels, the only reliable way to know if you have hypertension is to have your blood pressure measured regularly. It’s important to have your blood pressure checked at least every two years starting at age 18. Some people may need more frequent checks depending on their risk factors.^[1]

Preventing High Blood Pressure

The encouraging news about hypertension is that many cases can be prevented through healthy lifestyle choices. Even if you have risk factors you can’t change, like age or family history, you can still take steps to reduce your chances of developing high blood pressure or to keep it from getting worse if you already have it.

Making healthy dietary changes is one of the most powerful prevention tools available. Eating a diet rich in fruits and vegetables provides your body with important nutrients and helps maintain healthy blood pressure levels. These foods are natural sources of potassium, which is crucial for managing blood pressure. Foods like beets, berries, spinach, tomatoes, and bananas are particularly beneficial.^[22]

The DASH diet, which stands for Dietary Approaches to Stop Hypertension (an eating plan specifically designed to help prevent and treat high blood pressure), has been proven effective through research. This diet emphasizes fruits, vegetables, whole grains, and lean proteins while limiting saturated fats, trans fats, and sodium. What makes it practical is that it gives you a full variety and wide range of foods you can eat, not just restrictions.^[8]

Reducing salt intake is particularly important. The American Heart Association recommends limiting sodium to 2,300 milligrams daily, with most adults aiming for an ideal limit of 1,500 milligrams per day. To put this in perspective, some canned soups contain as much as 800 milligrams or more of sodium per cup. Most dietary salt comes from prepared foods like restaurant fare, canned foods, cold cuts, bread, and pizza, rather than from the salt shaker on your table.^[19][22]

Staying physically active is another essential prevention strategy. Exercise lowers your blood pressure by strengthening your heart and blood vessels. You don’t need to join a gym or start an intensive exercise routine. Moderate activities like walking, dancing, and cycling make a big difference, as long as you do them regularly. Aim for at least 30 minutes of exercise at least five days a week. You can even break this up into 10-minute periods throughout the day if that works better for you. Simple exercises like sitting in a chair and standing up as many times as you can until you get tired can be a great starting point.^[8][12]

Maintaining a healthy weight is crucial for prevention. If you’re carrying extra weight, losing even a small amount can help prevent or lower high blood pressure. Blood pressure might go down by about 1 mm Hg with each kilogram (about 2.2 pounds) of weight lost. The size of your waistline also matters. Men are at risk if their waist measurement is greater than 40 inches, while women are at risk if their waist measurement is greater than 35 inches.^[12]

Avoiding tobacco in all forms is essential. Any amount of smoking, including an occasional cigarette and breathing secondhand smoke, increases your risk of cardiovascular disease and high blood pressure.^[20]

Limiting alcohol consumption helps keep blood pressure in a healthy range. Drinking too much alcohol, too often, can raise your blood pressure. The American Heart Association recommends limiting alcohol to one drink per day.^[21]

Managing stress is another important prevention strategy. Though stress alone may not cause hypertension, reducing stress goes a long way toward lowering blood pressure and preventing it from rising in the first place.^[20]

How Hypertension Affects Your Body

Understanding what happens inside your body when you have high blood pressure can help explain why this condition is so dangerous and why treatment is so important. The damage occurs gradually, often over many years, which is another reason why symptoms don’t appear until significant harm has already been done.

Your blood travels to all the different parts of your body through the cardiovascular system (the network of your heart and blood vessels that delivers blood throughout your body). This system starts with your heart and connects to a huge chain of blood vessels, including arteries (blood vessels that carry oxygen-rich blood from your heart to your organs) and veins (blood vessels that carry low-oxygen blood back to the heart).^[8]

Blood vessels work somewhat like rubber bands. When your heart pumps, blood squeezes through these vessels, and they stretch out and snap back like elastic. That snapback motion is what keeps blood propelling forward throughout the body until it reaches all your organs. When pressure inside these vessels is consistently too high, several harmful changes begin to occur.^[8]

Think of it like trying to squeeze a tube of toothpaste. If the tube is tight, you have to squeeze very hard to get even a little bit of toothpaste out. The same thing happens in your blood vessels. If the pressure is high because your blood vessels are tight, your heart has to work much harder to move blood through the body. Over time, this extra work causes the heart muscle to grow. Unfortunately, the body can’t sustain this growth for long, and this can lead to serious problems.^[8]

The ongoing pressure damages your arteries, making them weaker and less flexible. Instead of being elastic like healthy vessels, they become stiff and damaged. This damage puts excessive stress on your heart and also affects other vital organs including your kidneys and brain.^[9]

Your heart is forced to work harder constantly. When this happens over months and years, it can lead to heart failure (a condition where the heart can’t pump blood effectively enough to meet the body’s needs). In older adults, about 70% of all heart failure cases are caused by high blood pressure.^[9]

The damage to blood vessels can result in several other serious complications. Blood flow can be interrupted to or within the brain, causing a stroke (when blood flow to part of the brain is blocked or when a blood vessel in the brain bursts, damaging brain tissue). High blood pressure is also a leading cause of heart attacks (when blood flow to part of the heart muscle is blocked) and can lead to kidney disease, eye disease, and problems with thinking and memory.^[9]

There’s even a subtype of dementia called vascular dementia (a decline in thinking skills caused by reduced blood flow to the brain) that is much more prevalent in patients with high blood pressure. The thought is that high blood pressure contributes to blockages in small blood vessels of the brain, injuring it over time, which can eventually lead to dementia.^[19]

Blood pressure is written as two numbers. The first number, called systolic blood pressure (the top number in a blood pressure reading), measures the pressure in blood vessels when your heart contracts or beats. The second number, called diastolic blood pressure (the bottom number in a blood pressure reading), represents the pressure in the vessels when your heart rests between beats.^[1]

Normal blood pressure is less than 120/80 mm Hg. In the United States, healthcare providers define hypertension as a top number of 130 mm Hg or higher, or a bottom number of 80 mm Hg or higher. Your blood pressure changes throughout the day based on your activities, but having blood pressure consistently above normal may result in a diagnosis of high blood pressure. The higher your blood pressure levels, the more risk you have for other health problems.^[4][6]