By Tanner Lambson 

One out of every two Americans is living with high blood pressure, and of those, only slightly more than half are aware they have it.  

That’s why high blood pressure — which often has no symptoms — is referred to as “the silent killer.” Without proper monitoring and treatment, high blood pressure can damage many organs and lead to heart failure, stroke and kidney disease.  

“I encourage everyone, whether you think you’re at risk or not, to be proactive. Monitor your blood pressure, discuss results with your doctor and don’t underestimate the power of lifestyle changes — be it a healthier diet, regular physical activity or weight management,” said VCU Health Pauley Heart Center cardiologist Michael Lenhardt, M.D., FACC. “Small steps can have a huge impact, and together, through better primary care and public awareness, we can start to lower the burden of hypertension in our communities.” 

Lenhardt sees patients at VCU Medical Center, VCU Health Tappahannock and VCU Health Community Memorial Hospital. He walked us through the fundamentals of hypertension as well as the practical, day-to-day strategies every patient can adopt to better manage their risks.  

What is high blood pressure?  

High blood pressure, also known as hypertension, is a condition where the force of your blood pushing against the walls of your arteries is consistently too high. We measure blood pressure with two numbers. The top number (systolic) represents the pressure when your heart beats, and the bottom number (diastolic) reflects the pressure when your heart rests between beats.  

Normal blood pressure is defined as less than 120/80 mmHg. When the systolic reading gets into the range of 130 to 139 mmHg or the diastolic reading is between 80 to 89 mmHg, the patient has stage one hypertension. Stage two is when the systolic pressure exceeds 140 mmHg, or the diastolic pressure goes above 90 mmHg.  

Why is hypertension often called the “silent killer”? 

One factor that makes hypertension particularly dangerous is its silent nature. Many people have elevated blood pressure without any obvious symptoms, which means that damage can occur quietly over time. It’s crucial, therefore, to have your blood pressure checked regularly.  

What are the main causes and risk factors for developing high blood pressure?  

High blood pressure can generally be divided into two categories: primary and secondary. 

Primary hypertension is largely driven by genetic factors. In these cases, you might notice that high blood pressure runs in families, even if we haven’t pinpointed every specific gene responsible for it.  

There’s no single reversible cause, so long-term management and lifestyle changes are critical. Factors such as obesity, diabetes and even sleep apnea contribute significantly to the development of high blood pressure. This means that our modern lifestyle — a combination of sedentary habits and diets high in sodium — has a direct impact on our cardiovascular well-being. 

Then, there’s secondary hypertension. Here, an underlying condition — such as thyroid disorders, kidney problems or other endocrine abnormalities — leads to elevated blood pressure. The good news with secondary hypertension is that once the underlying cause is identified and treated, blood pressure often normalizes.  

How frequently should individuals get their blood pressure checked?  

While there isn’t a one-size-fits-all answer, it’s never too early to start monitoring your blood pressure. Even if you’re young, if you have a family history of hypertension, diabetes or kidney issues, regular checks become particularly crucial.  

For someone with risk factors, getting your blood pressure checked on a routine basis can make a big difference in early detection and prevention. For most healthy adults without risk factors, annual checks will suffice.  

How does high blood pressure affect our organs over time? 

High blood pressure doesn’t impact just the heart — it exerts a toll on multiple organ systems. I’m particularly concerned about three main areas: the heart, the kidneys and the brain. 

For the heart, prolonged exposure to elevated blood pressure can lead to hypertrophy, where the heart muscle thickens. This thickening eventually makes the heart less compliant, meaning it can’t relax as efficiently when it fills with blood (diastole phase). This can lead to shortness of breath, decreased exercise tolerance and eventually heart failure.  

Additionally, high blood pressure is a major contributor to plaque buildup in the arteries (atherosclerosis), further elevating the risk for heart attacks and strokes.  

The kidneys are vulnerable, too. High pressure can damage the tiny blood vessels in the kidneys, leading to kidney failure — a situation where patients might ultimately require dialysis. And in the brain, the impact of uncontrolled hypertension is most visibly seen in strokes.  

Even if one specific organ seems to be less affected initially, the overall strain of high blood pressure increases the likelihood of adverse effects across all of these critical systems.  

Even though we say hypertension a “silent killer,” are there any symptoms patients can watch for?  

Unfortunately, one of the most dangerous aspects of high blood pressure is that it is often asymptomatic until sometime later in the disease process. Many people go years without noticing any changes until complications arise. In some cases, you might experience nonspecific symptoms such as an unexplained headache or visual disturbances.  

However, one of the earliest signs related to the heart is shortness of breath during activity. With chronic high blood pressure, the heart’s ability to relax and fill properly is compromised, leading to an exercise-induced shortness of breath that might go unrecognized as a warning sign. Because of the silent progression, relying on symptoms alone is not enough. Regular monitoring is paramount. 

Read more heart health stories on the Pauley Heart Center Blog

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