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By Barbara Mantel

Most women worry about cancer, but many don’t realize they have much more to fear from heart disease. 

While fewer Americans are dying of heart disease, it remains the number one killer of women in the United States, claiming more women’s lives than all forms of cancer combined.  

Heart disease causes 1 in 3 deaths among women each year — that’s approximately one woman every minute. One important way women and men can reduce their heart disease risk is to manage their blood pressure.  

“High blood pressure is a strong contributor to the development of heart attack and heart failure, and it is a major contributor to stroke,” Dr. Mariell Jessup, president of the American Heart Association and a professor of medicine at the University of Pennsylvania, told NBC News.   

A third of U.S. adults — or roughly 78 million Americans — have high blood pressure, often referred to as hypertension, but only a little more than half of hypertensive adults have their blood pressure under control, according to the American Heart Association. Many don't even know they have what's called the "silent killer."

“That is why we recommend a regular, annual check,” says Jessup. 

A blood pressure reading can be done at a doctor’s office, at home, in a drug store, or by a health professional at work.

Blood pressure measures the force against artery walls as the heart pumps blood through the body and is given as two numbers: a top number, called systolic blood pressure, and a bottom number, called diastolic blood pressure.  

  • Optimal blood pressure for men and women is 120 over 80 or lower. 
  • Anything consistently equal to or above 140 over 90 is considered high. Blood pressure between high and optimal is called pre-hypertension and bears watching.

But one high reading is not cause for concern. 

A government-appointed panel of independent experts recommends that “hypertension be diagnosed only after 2 or more elevated readings are obtained on at least 2 visits over a period of 1 to several weeks.” 

“Part of the reason is there is a lot of variability in blood pressure,” says cardiologist Michael A. Chen, a professor of medicine at the University of Washington. “Also, someone without hypertension could have a single high reading because they were very upset or had just exercised.”

Although some diseases, such as chronic kidney disease and disorders of the adrenal gland, can cause high blood pressure, most of the time, doctors don’t know the cause. There are several factors that can put an individual at risk, according to the National Institutes of Health, including: 

  • Being African American
  • Obesity
  • Stress or anxiety
  • Drinking too much alcohol
  • High salt diet
  • Smoking cigarettes
  • Family history of hypertension
  • Diabetes

To prevent or manage high blood pressure, doctors recommend losing weight, reducing alcohol and salt intake, stopping smoking, managing stress and starting regular exercise. 

“Even if patients still need medications, those lifestyle changes could reduce the number of medications they use or the dosages,” says Chen.

There are a “plethora” of medications to treat hypertension, says Jessup, and many patients need more than one. 

But there is some controversy about when to use them in older patients. In December, an expert panel recommended tolerating a higher systolic blood pressure of 150 in patients age 60 and over before resorting to medication. Some older patients can faint and fall if their blood pressure is lowered too aggressively, said the panel.

Citing weak evidence for any change, the American Heart Association is sticking to its current guidelines to treat all adult patients with consistent readings of 140 over 90 with lifestyle changes and, if necessary, medication. Only at age 80 or more should doctors tolerate a higher systolic reading of up to 150, these guidelines say.

And even the panel said it is ultimately a decision between patient and doctor.

“Given the vast number of people who don’t even know that they have high blood pressure, having people diagnosed and treated is probably more important than specific goals,” says Chen.

To raise awareness of women’s heart disease risk, the American Heart Association has declared February 7 National Wear Red Day.)