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The Healthy Heart Handbook for Women

Major Risk Factors for Heart Disease

High Blood Pressure
High blood pressure, also known as hypertension, is another major risk factor for heart disease, as well as for kidney disease and congestive heart failure. High blood pressure is also the most important risk factor for stroke. Even slightly high levels increase your risk for these conditions.

New research shows that at least 65 million adults in the United States have high blood pressure—a 30-percent increase over the last several years. Equally worrisome, blood pressure levels have increased substantially for American children and teens, raising their risk of developing hypertension in adulthood.

Major contributors to high blood pressure are a family history of the disease, overweight, and eating a diet high in salt and sodium. Older individuals are at higher risk than younger people. Among older individuals, women are more likely than men to develop high blood pressure. African American women are more likely to develop high blood pressure, and at earlier ages, than White women. But nearly all of us are at risk, especially as we grow older. Middle-aged Americans who don't currently have high blood pressure have a 90-percent chance of eventually developing the disease.

High blood pressure is often called the "silent killer," because it usually doesn't cause symptoms. As a result, many people pay little attention to their blood pressure until they become seriously ill. According to a national survey, two-thirds of people with high blood pressure do not have it under control. The good news is that you can take action to control or prevent high blood pressure, and thereby avoid many life-threatening disorders. Another new blood pressure category, called prehypertension, has been created to alert people to their increased risk of developing high blood pressure so that they can take steps to prevent the disease.

What Is Blood Pressure?
Blood pressure is the amount of force exerted by the blood against the walls of the arteries. Everyone has to have some blood pressure so that blood can get to all of the body's organs.

Usually, blood pressure is expressed as two numbers, such as 120/80, and is measured in millimeters of mercury (mmHg).The first number is the systolic blood pressure, the amount of force used when the heart beats. The second number, or diastolic blood pressure, is the pressure that exists in the arteries between heart beats.

Because blood pressure changes often, your health care provider should check it on several different days before deciding whether your blood pressure is too high. Blood pressure is considered "high" when it stays above prehypertensive levels over a period of time. (See table below.)

Understanding Risk
But numbers don't tell the whole story. For example, if you have prehypertension, you are still at increased risk for a heart attack, stroke, or heart failure. Also, if your systolic blood pressure (first number) is 140 mmHg or higher, you are more likely to develop cardiovascular and kidney diseases even if your diastolic blood pressure (second number) is not too high. Starting around age 55, women are more likely to develop high systolic blood pressure. High systolic blood pressure is high blood pressure. If you have this condition, you will need to take steps to control it. High blood pressure can be controlled in two ways: by changing your lifestyle and by taking medication.

Your blood pressure is determined by the higher number of either your systolic or your diastolic measurement. For example, if your systolic number is 115 mmHg but your diastolic number is 85 mmHg, your category is prehypertension.

Systolic Diastolic
Normal Less than 120 mmHg Less than 80 mmHg
Prehypertension 120-139 mmHg 80-89 mmHg
Hypertension 140 mmHg or higher 90 mmHg or higher

Changing Your Lifestyle
If your blood pressure is not too high, you may be able to control it entirely by losing weight if you are overweight, getting regular physical activity, cutting down on alcohol, and changing your eating habits. A special eating plan called "DASH" can help you lower your blood pressure. DASH stands for "Dietary Approaches to Stop Hypertension."

The DASH eating plan emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole-grain products, fish, poultry, beans, seeds, and nuts. The DASH eating plan also contains less salt/sodium, sweets, added sugars, sugar containing beverages, fats, and red meats than the typical American diet. This heart healthy way of eating is lower in saturated fat, and cholesterol, and is rich in nutrients that are associated with lowering blood pressure—mainly potassium, magnesium, calcium, protein, and fiber.

If you follow the DASH eating plan and also consume less sodium, you are likely to reduce your blood pressure even more. Sodium is a substance that affects blood pressure and is the main ingredient in salt.

Because fruits and vegetables are naturally lower in sodium than many other foods, DASH makes it easier to eat less sodium. Try it at the 2,300 milligram level (about 1 teaspoon of table salt). Then, talk to your doctor about gradually lowering it to 1,500 milligrams a day. Choose and prepare foods with less salt and don't bring the salt shaker to the table. And remember, salt/sodium is found in many processed foods, such as soups, convenience meals, some breads and cereals, and salted snacks.

For more on the DASH eating plan and how to make other changes that can lower and prevent high blood pressure, see "Taking Control".

Preventing Congestive Heart Failure
High blood pressure is the #1 risk factor for congestive heart failure. Heart failure is a life-threatening condition in which the heart cannot pump enough blood to supply the body's needs. Congestive heart failure occurs when excess fluid starts to leak into the lungs, causing tiredness, weakness, and breathing difficulties.

To prevent congestive heart failure, and stroke as well, you must control your high blood pressure to below 140/90 mmHg. If your blood pressure is higher than that, talk with your doctor about starting or adjusting medication, as well as making lifestyle changes.

To avoid congestive heart failure, controlling your weight is also very important. Being even moderately overweight increases your risk of developing heart failure.

Picture of Rosario Wearing Red.

"I have to lose weight and reduce my cholesterol. This is just the beginning of a long battle, and I know it won't be easy, but I know I have to do it."

—  Rosario

Taking Medication
If your blood pressure remains high even after you make lifestyle changes, your doctor will probably prescribe medicine. Lifestyle changes will help the medicine work more effectively. In fact, if you are successful with the changes you make in your daily habits, then you may be able to gradually reduce how much medication you take.

Taking medicine to lower blood pressure can reduce your risk of stroke, heart attack, congestive heart failure, and kidney disease. If you take a drug and notice any uncomfortable side effects, ask your doctor about changing the dosage or switching to another type of medicine.

A recent study found diuretics (water pills) work better than newer drugs to treat hypertension and to prevent some forms of heart disease. If you're starting treatment for high blood pressure, try a diuretic first. If you need more than one drug, ask your doctor about making one a diuretic. And, if you're already taking medicine for high blood pressure, ask about switching to or adding a diuretic. Diuretics work for most people, but if you need a different drug, others are very effective. To make the best choice, talk with your doctor.

Remember, it is important to take blood pressure medication exactly as your doctor has prescribed it. Before you leave your doctor's office, be sure you understand the amount of medicine you are supposed to take each day and the specific times of day you should take it.

Stroke: Know the Warning Signs
Stroke is a medical emergency. If you or someone you know has a stroke, it is important to recognize the symptoms so you can get to a hospital quickly. Getting treatment within 60 minute scan prevent disability. The chief warning signs of a stroke are:

  • Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body).

  • Sudden confusion, trouble speaking, or understanding speech.

  • Sudden trouble seeing in one or both eyes.

  • Sudden trouble walking, dizziness, or loss of balance or coordination.

  • Sudden severe headache with no known cause.

If you think someone might be having a stroke, dial 9-1-1 immediately. Also, be sure that family members and others close to you know the warning signs of a stroke. Give them a copy of this list. Ask them to call 9-1-1 right away if you or someone else shows any signs of a stroke.

Table of Contents Next: High Blood Cholesterol

Last Updated: February 29, 2012

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