The national health and nutrition examination survey (NHANES) conducted from 2005 through 2008 estimated that approximately 29 to 31 percent of adults in the United States have hypertension. This translates into 58 to 65 million hypertensives in the adult population in the United States.

The number of patients with hypertension is likely to grow as the population ages, since either isolated systolic hypertension or combined systolic and diastolic hypertension occurs in the majority of persons older than 65 years. The rising incidence of obesity will also increase the number of hypertensive individuals.

Despite the prevalence of hypertension and its associated complications, control of the disease is far from adequate. Data from the 2005-2008 NHANES survey show that only 46 to 51 percent of persons with hypertension have their blood pressure under control, defined as a level below 140/90 mmHg.

There are numerous potential reasons for low rates of blood pressure control, including poor access to health care and medications and lack of adherence with long-term therapy for a condition that is usually asymptomatic (producing or showing no symptoms). The latter may be particularly true when the therapy may interfere with the patient’s quality of life and when its immediate benefits may not be obvious to the patient. Thus, hypertension will likely remain the most common risk factor for heart attack and stroke.

What is High Blood Pressure?

Health class taught us that the arteries in your body take oxygenated blood from your heart and deliver it throughout your body to all your organs.  Pretty important right?  When we are young and healthy our arteries are stretchy and are able to widen easily to withhold the pressure of our blood racing through them.  Through the natural aging process and wear and tear from diet and lifestyle choices, our arteries become calcified and less elastic.  As the elasticity decreases, it becomes much harder for the blood to pump through a smaller area.  Imagine a fire hydrant trying to pump the same amount of water through a straw.  This is hypertension.

What causes the wear and tear?

Many different factors often combine to cause someone to have high blood pressure.  Some of these factors are preventable, and some are not.

The non-preventable causes of high blood pressure include things like genetics, race, gender, and age.  For example, hypertension is twice as likely in an individual that has had 1 or 2 hypertensive parents.  High blood pressure is more likely and is often more severe in African Americans.  Males are more likely than females to get hypertension, and as discussed before, increased age is a risk factor for high blood pressure as well.

There are many other factors that are completely preventable.  These include obesity, smoking, excessive alcohol intake, physical inactivity, and high salt diet.  Things like smoking and alcohol cause the blood vessels to constrict or become smaller, causing the pressure to increase.  High salt diets cause us to hold in more water which increases the volume of the blood that moves through our body, which increases the pressure.  Obesity causes hypertension in many ways.  One is that it increases the area the blood must circulate, causing the heart to work more strenuously.

What do the numbers mean?

Now that we know what it is and what causes it, let’s break down those mystery numbers.  When you go to your doctor’s office or urgent care, the first thing they do is squeeze your arm with a cuff, and give you a set of numbers.  One on top and one on the bottom.  Turns out it’s not so confusing.  The number on top is the “pressure” in your arteries as your heart PUMPs blood out to your body, this is generally the higher number and most looked at.  The number on the bottom is the “pressure” in your arteries when the heart is relaxing, and is generally the lower number.  A blood pressure of 120/80 mmHg (read 120 over 80 millimeters of mercury) is considered ideal.  Stage 1 hypertension is when the top or bottom number is greater than 140/90.  Stage 2 hypertension is when one is greater than 160/100.

Why is it called the “silent killer”?

In general, high blood pressure does not have any symptoms, which allows it to possibly be present for a very long time before it is caught or before a person will seek treatment.  It is not like a broken arm or sinus infection, where people actually feel pain or badly and request treatment, but the effects of high blood pressure is much more damaging.  Untreated hypertension is the number one risk factor for heart disease, which causes things such as heart attacks, strokes, diabetes, sudden death and heart failure.  Remember our fire hydrant into a straw analogy?  Now imagine your heart pumping to push the water through such a small space, and you can imagine how your heart has to work overtime when you have hypertension.  This is why it is important, even if you feel fine, to go to your clinician for yearly check-ups, especially if you have a family history or the risk factors we discussed above.

What can you do to prevent and treat high blood pressure?


Start in the kitchen. There are actually some diets that can help to lower your blood pressure.  One of the best things to do is to decrease your salt intake.  While you may not add salt to things, it is a good idea to take a look at labels next time you’re shopping.  It can be surprising how much salt is in your favorite foods!

The DASH diet is the “Dietary Action to Stop Hypertension”.  This diet is high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, and nuts.  It is also low in sugar-sweetened beverages and red meats.

Weight Loss

Along with dietary changes, weight loss is one of the best treatments of high blood pressure.  For every pound lost there is an average decrease of about 1 point in your blood pressure.  So even just a 5 lb. weight loss can mean a huge difference in blood pressure.


Independent from weight loss, exercise is another great treatment for hypertension.  Partaking in about 40 minutes of aerobic exercise 3-4 times per week can reduce Blood Pressure 6 points! Incorporating weight training can drop it 3 more points.

Limit Alcohol, Stop Smoking

Other things to do at home are limiting alcohol intake and smoking cessation.  Sometimes making these lifestyle changes is not enough and you may need medical therapy.  You and your clinician will be able to decide what type of medicine is right for you, but medication should always be used in addition to your lifestyle modifications at home.

As a family practice Physician Assistant at FastMed Family Practice in Asheville, I am passionate about educating my patients and community about general health maintenance and preventable conditions like hypertension. Now that you have the low down on high blood pressure, give us a call to get an appointment for you blood pressure screening and wellness exam today!

Amy Kosich, PA-C
FastMed Family Practice of Asheville

Amy is family practice provider at FastMed Family Practice at FastMed Urgent Care in Asheville, North Carolina. For more information on FastMed’s family practice services or to make Amy your family’s medical provider, click HERE or call 828.210.2835 today.

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