Patient receiving blood pressure check

—Blake B.*, Ashford University, San Diego, California

(*Name changed)

While it’s unusual for college students to have high blood pressure, it’s by no means unheard of, especially as rates of activity decline and rates of obesity increase.

High blood pressure, or hypertension, is a common medical disorder, affecting about a third of the population. Only about half of people who have hypertension have it under control, usually because of lack of access to medical care or irregular use of treatment medications. But hypertension that goes untreated for years increases the risk for heart attack, stroke, kidney failure, and other serious consequences, so it’s important to take care of yourself.

A normal blood pressure is a reading of less than 120 over 80. A high blood pressure is a reading of 140 over 90 or higher, according to the National Institutes of Health. Here’s what you can do to make sure you’re in a healthy range:

Step 1: Confirm that you have high blood pressure

Make an appointment at your student health service or with your primary care provider to discuss your concerns. Most students who think they have high blood pressure actually turn out to be in the normal range. Usually, they’ve obtained a poor-quality measurement either by an automated machine or inexpert person.

To take your blood pressure properly, you should be sitting in a relaxed position for several minutes, and an appropriately sized cuff should be used. Activity and cuffs that are too small can falsely raise readings, as do pain, nervousness, and other factors. Some people have “white-coat hypertension,” meaning they’re nervous about being in a medical setting. If I get a high number, I usually repeat the reading at the end of the exam after having some friendly conversation, which can make the patient more relaxed and comfortable.

By definition, elevated blood pressure must be present on several measurements over multiple visits to confirm the diagnosis of hypertension. If my suspicion is low, (i.e., if the patient is young and healthy without family history of high blood pressure or other risk factors), I recommend exercise, offer smoking cessation counseling when needed, discuss diet, and plan several re-checks over the next three to six months. We don’t want to delay diagnosis of hypertension, but we can take a few months to make sure we’re right, especially with young people. 

Illustration of blood pressure test

Step 2: Establish the details of your type of high blood pressure

The most common type of high blood pressure is primary hypertension (formerly called essential hypertension). Major risk factors include advanced age (50s and older), obesity, family history, and being African American.

Some people have secondary hypertension, meaning that their high blood pressure is due to a medication, kidney condition, or other medical cause. A thorough medical evaluation is warranted when the history or response to treatment suggests the possibility of secondary hypertension.

Step 3: Do what your primary care provider advises

Sometimes, blood pressure can be maintained (or lowered, if in a high range) by paying specific attention to diet and exercise. Interestingly, though weight loss usually helps, it isn’t always essential. Sometimes just regular exercise is enough.

If you’re prescribed medication, work with your provider to be sure that it’s affordable and tolerable. Also, talk with them about how realistic it would be for you to come off the medicine if you could make significant lifestyle changes.

Bottom line: High blood pressure is a serious medical condition that usually requires lifelong medical treatment. It’s hard and frustrating to face up to such a reality, but the consequences of delaying or avoiding treatment can potentially be life-threatening.