Salty meals can lead to high blood pressure, the cause of a wide variety of other health conditions.

Hypertension, also known as high blood pressure, is a silent killer that lurks among us, helping to claim millions of lives every year.

According to a new study published in The Lancet, the number of kids under age 19 who have high blood pressure has doubled worldwide since 2000. The rest of the population isn’t faring much better either: In the US, nearly half of Americans have hypertension — twice the rate from a generation ago.

Key takeaways

Many Americans, particularly young adults, don’t know they have high blood pressure.If unchecked, high blood pressure can lead to a lot of health problems: heart disease, lung disease, kidney disease, and even dementia. It also raises your risk of a deadly heart attack or stroke.Low-sodium, low-fat diets rich in fiber and potassium can lower your blood pressure, as can a dedicated aerobic workout routine. Wearables, like an Oura ring or Apple Watch, and GLP-1s offer new potential to control hypertension, but they are still in the early stages.

That might mean you, too. And I’m sorry, but the news gets worse: Thanksgiving is the disease’s favorite time of year. It seems our social calendar and our food supply are conspiring to give each of us this too-often-overlooked condition — with potentially deadly consequences.

Only about half of the people who have hypertension have it under control, a figure that has been declining over the past 10 years, even though this is among the most tractable public health problems that we have. With better monitoring, lifestyle modification, and medication, it is possible to reduce someone’s high blood pressure.

But the problem is, many of the people who have it, especially younger patients, are totally unaware.

Why hypertension is so dangerous

What is high blood pressure, exactly?

Your blood pressure measures how hard the blood pumping through your veins is pushing against the walls of your arteries, and it serves as a proxy for how hard your heart and circulatory system have to work to move blood through your body. If you’ve ever had a physical exam or a routine check-up with your doctor, you’ve probably had your measurement taken using either a manual or automatic cuff. The standard healthy reading is 120/80 (the top figure measures the pressure during a heartbeat, and the bottom measures the pressure during those brief moments in between heartbeats).

If both numbers fall below that standard, it is considered to be a healthy reading. Anything above that starts to have negative consequences. First, arteries begin to harden, and organs can be damaged over time.

But high blood pressure and its effects on your body’s function can lead to other issues as well. It can damage your kidneys; hypertension is one of the leading causes of chronic kidney failure. It can damage your eyes, which are filled with tiny blood vessels, causing vision problems. And it can affect your cognition, driving up your risk of Alzheimer’s disease and dementia. Both your kidneys and your brain rely on being efficient filters in order to function; when the blood vessels inside of them get damaged, they become less efficient at filtering the bad stuff out of your body or your brain.

Over time, your blood pressure starts to rise — and a wide range of health problems can follow. The most obvious are heart attacks and strokes: Your blood vessels are damaged, and they start to accumulate plaque that further slows the flow of blood. When your blood flow becomes too obstructed, you can have a heart attack (if the blockage is near your heart) or a stroke (if it is in your brain) or a pulmonary embolism (if it is in your lungs).

When that happens gradually, it can lead to heart disease or chronic obstructive pulmonary disease (COPD) over the long term. Those conditions can kill you — either through a heart attack or pulmonary embolism. These are consistently among the leading killers in the US and worldwide, and even if you survive, you can face permanent paralysis or other lifelong limitations.

Its pernicious nature is why the medical community changed the definition of high blood pressure in 2017, significantly increasing hypertension rates in the US. Before then, the cutoff for high blood pressure was actually 140/90; anything between that and 120/80 was considered to be “pre” hypertension — a warning that you are on track for serious problems, but not in the final stage of the disease.

But as research continued to show that heart and blood vessel damage could occur even at lower readings, scientists reconsidered. The final straw came in 2015 when a large clinical trial of more than 9,000 people with elevated blood pressure found that lowering the patients’ blood pressure from 140/90 to 120/80 could cut their risk of serious cardiovascular events by 25 percent. When the definition was changed, US hypertension rates jumped from about 30 percent to nearly 50 percent.

Far more people were at risk than had previously believed.

And yet, despite being so obviously dangerous and so widespread, many people still don’t know if they have high blood pressure. By one estimate, nearly 40 percent of adults younger than 45 who have hypertension don’t know it. How can that be possible?

There is no obvious sign that you have it — unless you get checked regularly.

High blood pressure has a reputation among doctors as a “silent” killer: Patients sometimes experience no symptoms or very mild and vague symptoms. I once had a nurse remark to me that some people are walking around with blood pressures over 200 and have no idea.

It is only through the repeated and consistent measurement of your blood pressure over time that you can know with certainty whether you have a problem. A one-off reading — say, while you’re waiting at the pharmacy — can be misleading in either direction. Your blood pressure fluctuates throughout the day, and even if you have hypertension, you can get a normal reading sometimes. Conversely, if you have a spike of stress while being measured, you could have a high reading even without an underlying issue.

But here’s the problem: Many Americans, particularly young people, don’t see a health care provider regularly. Nearly half of the people in the US under 30 don’t have a primary care physician. And they may be paying the price: Data suggests heart attacks and other cardiovascular events are up among young adults.

What you can do to manage your blood pressure

Hypertension, like many diseases, does have a genetic or hereditary component — if you have a family history, you are at higher risk — but if you regularly eat too much sodium and do not get enough exercise, you’re putting yourself at risk, too. A traditional Thanksgiving dinner, for example, can easily have more sodium than any person is supposed to eat in an entire day. And lying on the couch for the entire afternoon after that meal isn’t helping either.

Luckily, Thanksgiving only comes once a year. But too many Americans eat salt-rich diets and stay sedentary the rest of the year, too.

You can change that. Doctors have come up with what they call the DASH (Dietary Approaches to Stop Hypertension) diet as the best strategy for managing your blood pressure. You should eat a lot of fruits and vegetables, beans and nuts, and whole grains. You should try to eat foods that are high in fiber and potassium (which helps your kidneys filter sodium); you, of course, want low-sodium and low-fat foods too. I typically buy the no salt added or reduced sodium options for, for example, chicken broth. Red meats and processed foods, both of which are linked to hypertension, are your enemies.

In the end, you want to eat between 1,500 and 2,000 milligrams of sodium in a day and no more. You could drink less alcohol and less caffeine, both of which raise your blood pressure temporarily, as well.

On the exercise front, working out is not always a foolproof weight-loss strategy — but it is proven to be effective in lowering your blood pressure. Walking, jogging, swimming, cycling, and even dancing are all good for you. But regardless of what you’re doing, your goal should be about 150 minutes per week. It is best to combine that classic “cardio” exercise with strength training (which both lowers blood pressure on its own and makes your aerobic workouts more effective) and even stretching and breathing routines like yoga, which can help regulate your heart and lead to better sleep. All of these things can help to keep your blood pressure down.

There is also a wide range of existing blood pressure medications, which can be very effective but do come with some risks, such as blood thinners that can cause excessive bleeding. We are entering a new age of medicine, however, in which wearable tech that allows patients to monitor their blood pressure minute by minute and GLP-1s are likely to become more commonplace.

Apple Watch rolled out a blood pressure monitoring capability this fall: You can turn on hypertension notifications, and your device will notify you if it detects consistently high blood pressure. The wearable tech company Oura Labs is working on something similar. Right now, the best way to monitor at home is to buy your own blood pressure cuff like the one at your doctor’s office; my own physician pointed me to the Omni units to monitor my blood pressure at home. They can cost as little as $40, and if you have an FSA or an HSA, it is an eligible expense.

But this can be a little inconvenient — you have to sit down, take a few minutes to get your blood pressure to “normal,” and then affix the cuff correctly to ensure you’ll get an accurate reading. Having the same capability walking around with you on your wrist at all times would be a boon, much like continuous glucose monitoring has helped people better manage their diabetes.

These are effectively brand new prototypes, however. As Apple itself warns, they should not be used to diagnose hypertension or to monitor and control it. Not everybody who has high blood pressure will have it detected by the Apple Watch. And it may not even be able to detect serious cardiac events, such as a heart attack.

Likewise, the new class of GLP-1 weight-loss drugs has shown modest benefits for hypertension, as well as reduced risk of heart attack and stroke. But that science is preliminary. We still have a lot to learn about those drugs and, even if they are effective, they would work best in tandem with a blood pressure-conscious diet and exercise routine.

The good news is that high blood pressure is a health problem you can do something about. You just have to figure out whether you have a problem in the first place.

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