Doctor’s Guide to Blood Pressure: Treatment, Risks, and Myths
High blood pressure, or hypertension, is one of the most common conditions we manage in primary care—and one of the most important to control. Even mild elevations over time increase the risk of stroke, heart attack, kidney failure, and cognitive decline. The good news is that effective treatments exist, and small changes can make a big difference.
Understanding Your Numbers
Blood pressure is measured using two numbers:
Systolic (the top number): pressure when the heart beats
Diastolic (the bottom number): pressure when the heart rests between beats
A normal reading is typically below 120/80 mmHg.
At PridePoint Health, we take a thoughtful, evidence-based approach to diagnosing and treating high blood pressure. In most cases, we follow the guidance of the American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and the Eighth Joint National Committee (JNC 8), which define hypertension as persistent blood pressure readings of:
140/90 mmHg or higher
From there, treatment goals vary depending on age and health history:
Adults under 60: We generally aim for a target of less than 140/90 mmHg.
Adults 60 or older without conditions that contribute to cardiovascular risk (e.g. diabetes, chronic kidney disease, etc.): We typically begin treatment if blood pressure reaches 150/90 mmHg, with a goal of keeping it below that threshold.
This approach helps reduce the risk of stroke, heart attack, and death—while avoiding unnecessary side effects like dizziness, fatigue, and falls.
Adults under 60 with other conditions (such as diabetes, chronic kidney disease, or cardiovascular disease): We often aim for a more tailored target of under 135/85 mmHg, based on evidence that tighter control modestly reduces the risk of heart attack.
These recommendations are individualized—balancing benefits with a person’s overall health and risk of side effects.
The American College of Cardiology and American Heart Association (ACC/AHA) take a more aggressive approach, recommending a target of under 130/80 mmHg, especially for high-risk individuals. While that may be appropriate for some patients, we typically follow a more conservative strategy that prioritizes safety—particularly in older adults.
What Raises Your Risk for High Blood Pressure?
While anyone can develop high blood pressure, certain factors make it more likely over time. These include:
Family history. Genetics can play a strong role. If close relatives have hypertension, your chances are higher—even with a healthy lifestyle.
Age. Blood pressure tends to rise gradually as we get older, especially after age 50.
Smoking. Tobacco use temporarily raises blood pressure and contributes to long-term hardening of the blood vessels.
Excessive alcohol intake. Drinking more than one drink per day (on average) is associated with higher blood pressure.
Body size and weight. Carrying more weight—especially around the abdomen (visceral fat)—can increase blood pressure by affecting how the body regulates fluid balance, hormones, and blood vessel function. Not everyone in a larger body has high blood pressure, but statistically, the risk is higher. The focus is on supporting overall cardiovascular health, not achieving a specific size.
Inactivity. A sedentary lifestyle makes it harder for the heart and blood vessels to stay flexible and responsive.
Diet high in sodium and low in potassium. Too much salt, not enough fresh fruits and vegetables.
Understanding your personal risk can help guide how we approach both prevention and treatment.
When Treatment Begins—and Why It Matters
Treatment decisions depend on your overall risk—not just the numbers. For people with a history of heart disease or high cardiovascular risk, studies show that treating even modest elevations (130–139 systolic) can save lives.
The SPRINT trial found that treating to a target of <120 systolic (rather than <140) reduced the risk of cardiovascular events by 25% and lowered the risk of death from any cause by 27%. That’s a number needed to treat (NNT) of just 61over 3 years to prevent one death.
Even in lower-risk individuals, blood pressure over 140/90 increases stroke risk significantly. In fact, for every 20-point increase in systolic pressure, the risk of stroke approximately doubles.
Lifestyle Changes That Really Work
We often start with lifestyle changes—and for many people, they’re powerful enough to lower blood pressure without medication. For example:
Reducing sodium to under 2,300 mg/day (or ideally 1,500 mg/day) can lower systolic pressure by 5–6 mmHg.
Following a DASH-style diet (rich in vegetables, whole grains, and plant-based fats) can reduce systolic pressure by 8–14 mmHg.
Regular physical activity, like brisk walking 30 minutes a day, can reduce systolic pressure by 4–9 mmHg.
These changes aren’t just about numbers—they’re about lowering your real-world risk of heart disease, stroke, and early death.
When Medications Are Needed
If lifestyle changes aren’t enough, medications are an important tool. But not all blood pressure drugs are equal when it comes to preventing serious outcomes like stroke.
For most people, the guidelines recommend starting with of three options:
A thiazide-type diuretic (such as chlorthalidone or indapamide)
An ACE inhibitor or ARB
A calcium channel blocker
Thiazides are highly effective—but they require careful use in older adults or those prone to low sodium. In patients over 65, we often start at a lower dose and monitor sodium closely to avoid complications.
The key is personalization. The right medication depends on your age, kidney function, other medical conditions, and how your body responds over time.
Why Blood Pressure Control Is Worth It
Controlling high blood pressure isn’t just about avoiding a future stroke—it’s about how you feel day to day. Many patients notice they sleep better, have fewer headaches, and feel more mentally clear when their blood pressure is well-controlled.
And the impact is real: lowering systolic pressure by just 10 mmHg reduces the risk of stroke by 35–40% and heart attack by 20–25%.
Common Myths About High Blood Pressure
Myth: You’ll know if you have high blood pressure because you’ll feel it.
Fact: High blood pressure usually causes no symptoms. That’s why it’s often called “the silent killer.” Many people feel perfectly fine even when their numbers are dangerously high.
Myth: If your blood pressure is only high at the doctor’s office, it’s not a problem.
Fact: White coat hypertension is real—but it still carries increased cardiovascular risk over time. Home monitoring helps us understand the full picture and make informed decisions about treatment.
Myth: Beta-blockers are the best medication for high blood pressure.
Fact: Beta-blockers (like metoprolol or atenolol) are no longer considered first-line treatment for most people with hypertension. They’re appropriate in certain situations—like after a heart attack or for heart failure—but for most patients, other medications provide better protection against stroke and cardiovascular events.
Myth: Herbal supplements like garlic, hibiscus, or beet juice are proven treatments.
Fact: Some herbal products may have a modest effect on blood pressure in small studies—but they are not a substitute for established therapies. The reductions tend to be small (often less than 5 mmHg), results are inconsistent, and dosages are not standardized. Worse, some supplements can interact with prescription medications or raise blood pressure unexpectedly. If you’re considering a supplement, talk to your doctor first.
Our Approach at PridePoint Health
We don’t believe in one-size-fits-all care. At PridePoint Health, we take the time to understand your health history, listen to your goals, and work with you on a plan that fits your life. That might mean starting with lifestyle changes, checking labs, adjusting medications, or simply giving you space to ask questions.
If you’re looking for a doctor who doesn’t just check a box—but truly partners with you on your health—we’d love to meet you.
You can learn more about our membership model, or schedule an introductory call to get started. Have questions about what we treat? Visit our FAQ page for more details.
Medical content reviewed by Dr. Ryan Coe, MD
Dr. Coe is a board-certified internal medicine physician and founder of PridePoint Health. He specializes in evidence-based primary care and inclusive, affirming medicine for adults of all backgrounds.
Disclaimer: Nothing in this post creates a physician-patient relationship with the reader.
Speak with your own health care provider prior to making any changes regarding your medications.
References
Whelton PK, Carey RM, et al. 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018;71(19):e127–e248.
SPRINT Research Group. A Randomized Trial of Intensive vs. Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103–2116. doi:10.1056/NEJMoa1511939
Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality. Lancet. 2002;360(9349):1903–1913.
He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2004;(3):CD004937.
Appel LJ, et al. Effects of comprehensive lifestyle modification on blood pressure control: the PREMIER clinical trial. JAMA. 2003;289(16):2083–2093.
Lindholm LH, et al. Cardiovascular morbidity and mortality in patients with hypertension treated with beta-blockers: a meta-analysis. Lancet. 2005;366(9496):1545–1553.