Just two weeks ago, the American Heart Association updated its definition of hypertension and recommendations for treatment. That’s important because high blood pressure remains one of the leading causes of heart attacks, strokes, kidney failure and dementia. The higher and longer your blood pressure stays elevated, the earlier in life these devastating diseases can appear.
But why exactly is hypertension such a “silent” killer?
The Vulnerable Lining of Blood Vessels
Every blood vessel in your body — arteries, veins and capillaries — is lined with a paper-thin layer called the endothelium, only one cell thick. This fragile lining acts as a protective barrier. When it’s intact, your vessels stay smooth and healthy.
But when the endothelium is damaged, trouble begins. Cracks or tiny tears allow inflammatory cells and cholesterol to infiltrate the vessel wall, triggering plaque buildup and narrowing of the artery. Over time, this can choke off blood flow and trigger a heart attack or stroke.
How High Blood Pressure Causes Damage
Hypertension exerts constant mechanical stress on that delicate lining. The pressure is especially harmful at spots where arteries branch or curve — such as the vessels feeding your heart and brain. Each surge of pressure is like water pounding against a weak spot in a dam. Eventually, the lining gives way, setting off the chain reaction of vascular injury.
This is why controlling blood pressure is one of the most effective ways to prevent heart disease, stroke, kidney disease and even cognitive decline.
Current Definitions of Blood Pressure
Here’s how blood pressure is now classified:
| Category | Systolic BP (top number) | Diastolic BP (bottom number) |
| Normal | Less than 120 | and less than 80 |
| Elevated | 120–129 | and less than 80 |
| Hypertension – Stage 1 | 130–139 | or 80–89 |
| Hypertension – Stage 2 | 140 or higher | or 90 or higher |
What You Can Do
Knowing your blood pressure is a vital sign of health. If it’s elevated, don’t ignore it. Work with your doctor to design a plan — whether lifestyle changes, medication or both — that’s tailored to you.
Because when it comes to blood pressure, lower truly is better. Protecting your endothelium today may save your heart, brain and kidneys tomorrow.
Dr. Charlie Barnett is a contributor at KnoxTNToday for a weekly column, DocTalk, providing his expertise on health and wellness management.
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