How seriously do I need to take prehypertension?

DEAR DOCTOR K:

I’m in my 20s. My doctor says I have prehypertension. How seriously do I need to take this?

DEAR READER:

Quite seriously. High blood pressure, or hypertension, is a blood pressure of 140/90 mm Hg or higher. Only a few decades ago, blood pressure lower than that was considered normal — or, at least, not worth worrying about.

But during the last 20 years, multiple long-term studies have shown that people with blood pressures higher than 120/80 but lower than 140/90 have an increased risk of heart disease and stroke. That’s why we now have the term prehypertension, which describes blood pressures between 120/80 and 139/89.

A recent study in The Journal of the American College of Cardiology included nearly 2,500 men and women. They were aged 18 to 30 years when the study began. Researchers measured their blood pressures seven times over the next 25 years. Near the end of the study, they had heart-imaging tests.

The researchers found that people who had prehypertension when they were between the ages of 18 and 30 were more likely to have signs of heart disease in middle age.

Every adult should get their blood pressure checked at least once per year. You don’t have to see a doctor to do it. Many drugstores have blood pressure machines you can use for free, or take advantage of free health screenings at work or in your community. You can also purchase a home blood pressure monitoring machine. They are accurate and inexpensive. The best and easiest to use involve a cuff around your upper arm (as in the doctor’s office) and automatically take your blood pressure. You just sit there.

Now that you know your blood pressure is slightly elevated, lifestyle changes can help to get it back under control:

First, if you smoke, make quitting your top priority.

Next, improve your diet and exercise habits. These changes will help dial back your blood pressure and reduce your risk of heart problems and stroke later on.

  • Maintain a healthy weight.
  • Make vegetables and fruits half of every meal.
  • The other half should contain healthy protein and whole-grain carbohydrates.
  • Reduce salt intake. Use a little less salt every day to help your taste buds adjust.
  • Drink water instead of sugary beverages.
  • Be as physically active as you can all day.
  • Get at least 30 minutes of moderate-intensity exercise most days of the week.

Some young people with prehypertension probably could benefit from drug treatment to lower blood pressure. That might be something to discuss with your doctor if lifestyle changes don’t have enough of an impact.

When I graduated medical school, it seemed most doctors didn’t start really worrying about blood pressure until it was 160/100 or higher. As I’ve said, now we start worrying when it’s higher than 120/80. Why the change? Because scientific studies involving literally millions of people over many decades has taught us when we should worry, and given us tools (lifestyle changes, medicines) that reduce the risk.