What You Need to Know About High Blood Pressure
By: Brian Hoeflinger, MD
March 22, 2026 | #81
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Disclaimer: Opinions are my own. Not medical advice.
Medical Trivia of the Week
Which part of the human body has the most blood vessels per square inch? (the correct answer is at the end of this email)
- A) Brain
- B) Heart muscle
- C) Retina of the eye
- D) Kidneys
The Silent Killer That Has No Symptoms
Walk into any Walgreens or other pharmacy chain in America and you will find one of the most important machines most people ignore. The blood pressure cuff. It is free to use and only takes about a minute but it could genuinely save your life.
High blood pressure, also known as hypertension, affects close to 120 million Americans right now. That is roughly 1 in 2 adults. And what's even scarier is that about 4 in 10 of those people have absolutely no idea.
No headaches. No dizziness. No pain. No warning. Just silent, steady damage happening inside the blood vessels, the heart, the brain, and the kidneys. Often for several years, before anything shows up on the surface.
That is why it is called the silent killer. And that is why I want to make sure you actually understand it.
What the Numbers Mean
Blood pressure is the force your blood exerts against artery walls as your heart pumps. A reading of 120 over 80 gives you two numbers. The top number (systolic) is the force when your heart squeezes. The bottom number (diastolic) is the force when your heart relaxes between beats.
Here is what those numbers mean:
- Normal: Below 120 / below 80
- Elevated: 120 to 129 / below 80
- Stage 1 Hypertension: 130 to 139 / 80 to 89
- Stage 2 Hypertension: 140 or higher / 90 or higher
- Hypertensive Crisis: Above 180 / above 120
If either number puts you in a higher category, that is where you stand. And if you ever hit above 180/120 with symptoms like chest pain, shortness of breath, or vision changes, call 911.
Why You May Not Feel It
This surprises a lot of people. There are no pain receptors on the inside of blood vessel walls. So as pressure rises and damage accumulates, your body sends no signal. None.
On top of that, your arteries contain pressure sensors that actually recalibrate over time. When blood pressure creeps up slowly over months and years, those sensors accept the higher pressure as the new normal and stop alerting the brain. Your own nervous system stops noticing.
According to CDC data, only about 59% of adults with hypertension know they have it. Among adults aged 18 to 39, roughly 73% are completely unaware. For many people, the first sign that something is wrong is a heart attack, a stroke, or kidney failure.
That is not a scare tactic. That is just the nature of a condition that does not announce itself.
What Is Happening on the Inside
Here is what is actually happening in the body.
Your arteries have a delicate inner lining. Sustained pressure creates tiny injuries to that lining. Your body tries to repair them, but the process attracts cholesterol and other material to those injury sites. Over time, plaque builds up. Arteries stiffen and narrow. The heart has to work harder. And as those vessels narrow, the organs downstream get less blood flow.
This is where the damage shows up:
- Heart. The muscle thickens and weakens from the added strain, raising the risk of heart attack and heart failure.
- Brain. Damaged arteries can block or burst, causing stroke. Over time, smaller vessel damage contributes to memory loss and dementia.
- Kidneys. The kidneys rely on millions of tiny blood vessels to filter waste. Sustained pressure destroys those filters, and hypertension is one of the leading causes of kidney failure in this country.
- Eyes. The retina's tiny vessels are especially vulnerable. Damage there can lead to vision loss, again with no warning.
All of this can begin within just a few years of sustained elevated pressure, long before anything feels wrong.
What You Can Do
The good news is that lifestyle modifications done consistently can meaningfully lower blood pressure.
- Get a home blood pressure monitor. An automatic, upper-arm cuff monitor costs around $30 to $50. Measure at the same times each day, sit quietly for five minutes first, and take two readings a minute apart. You cannot manage what you do not measure.
- Cut sodium. The average American consumes about 3,400 mg of sodium per day. People with hypertension should aim for closer to 1,500 mg.
- Move more. Aim for 90 to 150 minutes of moderate activity per week, things like brisk walking, cycling, or swimming. Regular aerobic exercise helps drop systolic pressure.
- Watch your weight. Every pound lost produces a measurable reduction in blood pressure. Even modest weight loss adds up quickly.
- Sleep well. Consistently poor sleep raises your risk significantly. If you snore heavily or wake up exhausted, talk to your doctor about sleep apnea. It is found in up to 80% of people with hard-to-control hypertension.
If you already know your blood pressure is elevated and have not spoken to a doctor yet, that conversation is the most important first step. Lifestyle changes and, when needed, medication work well together.
The bottom line is simple: you cannot feel high blood pressure, so you should regularly monitor for it.
Forward this email to a loved one who may not know about high blood pressure.
Impactful Quote of the Week
"It does not matter how slowly you go as long as you do not stop."
- Confucius
Please let me know what you thought of this newsletter by replying to this email.
All my best,
Brian Hoeflinger
P.S. - if you enjoyed this newsletter, you may enjoy my book that details my life as a neurosurgeon and the loss of my oldest son, Brian (see below a synopsis) and/or my podcast where I explain topics in further detail.
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Learn More About My Book
Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.
https://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinking
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Medical Trivia Answer:
The correct answer is C) Retina of the eye
*Disclaimer: This newsletter and blog is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this newsletter and blog or materials linked from this newsletter and blog is at the user’s own risk. The content of this newsletter and blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay seeking medical advice for any medical condition they may have and should consult their healthcare professionals for any such conditions.
