High blood pressure is one of the most important — and most treatable — risk factors for heart attack, stroke, kidney disease and dementia. It rarely causes symptoms, which is why it’s called the “silent killer”.
Why it rises in midlife
Before menopause, women tend to have lower blood pressure than men of the same age. After menopause, that advantage fades. Changes in blood vessel flexibility, weight gain, salt sensitivity and stress all contribute.
What the numbers mean
A reading has two numbers: systolic (pressure when the heart beats) over diastolic (pressure between beats). US guidelines classify readings as:
- Normal: below 120/80
- Elevated: 120–129 systolic and below 80 diastolic
- Stage 1 high blood pressure: 130–139 or 80–89
- Stage 2 high blood pressure: 140/90 or higher
A reading of 180/120 or higher, especially with symptoms like chest pain, shortness of breath or vision changes, needs emergency care.
Measure it properly
Single readings vary. Home blood pressure monitoring gives a better picture. For accurate readings: sit quietly for five minutes, back supported, feet flat, arm at heart level, and avoid caffeine and exercise for 30 minutes beforehand. Use a validated, upper-arm cuff.
What lowers blood pressure
- Less salt. Cutting sodium has a meaningful effect, especially in salt-sensitive people. Most salt comes from processed and restaurant foods.
- More potassium from fruit, vegetables and beans (unless you have kidney disease).
- The DASH eating pattern, rich in vegetables, fruit, whole grains and low-fat dairy, lowers blood pressure in trials.
- Regular exercise, both aerobic and strength.
- Weight loss if you have overweight.
- Less alcohol.
- Better sleep, including treating sleep apnea.
If lifestyle changes aren’t enough, blood pressure medications are effective, inexpensive and well studied.
Know your number
Check your blood pressure at least once a year from midlife — more often if it’s above normal.