A person can have dangerously high blood pressure for years and feel perfectly normal.
That is one reason heart disease remains so difficult to prevent: some of its most important warning signs are invisible. By the time symptoms appear, damage to blood vessels and the heart may already have developed.
Heart disease is still the leading cause of death in the United States, according to cardiovascular health data reported in the Journal of the American College of Cardiology. More than 82 million U.S. adults live with heart disease, and roughly half of adults have some form of cardiovascular condition when problems such as stroke and high blood pressure are included.
Cardiovascular disease is a broad term for conditions involving the heart and blood vessels. It includes coronary artery disease, in which the vessels supplying the heart become narrowed, and heart failure, in which the heart cannot pump as effectively as the body needs. High blood pressure can contribute to both problems.
Blood pressure is recorded with two numbers and shows how strongly blood presses against artery walls. If that pressure stays high, the arteries are exposed to extra strain every day. Over many years, this can damage their inner walls and make serious cardiovascular problems more likely.
In 2023, hypertension was a primary or contributing cause of around 664,000 deaths in the United States. Yet many people with it do not feel sick. This is why regular measurement is so important.
Rutgers Health cardiologist Alfonso Waller, a professor at Rutgers New Jersey Medical School, emphasizes that heart risk develops from a mixture of factors. Some, such as age and family history, are outside a person’s control. Others can be changed or medically managed.
Smoking, high cholesterol, diabetes, excess body weight and too little physical activity are among the best-known risks. High blood pressure is especially important because it can quietly increase the workload on the heart and damage arteries. Several risks occurring together can make the overall danger greater.
But heart health is not determined only by what happens inside the body. Research increasingly shows that people’s surroundings and financial circumstances can shape cardiovascular risk. Someone who cannot regularly afford nutritious food or reach preventive medical care faces different challenges from someone with easy access to both.
Where people live can matter too. A neighborhood without safe footpaths, parks or convenient places to exercise can make daily activity more difficult. Exposure to air pollution or secondhand smoke may add further strain on cardiovascular health.
These social differences help explain why some populations experience heart disease earlier or have worse outcomes. Communities of color in the United States have faced higher burdens of cardiovascular disease in many studies. Differences in access to care, economic conditions, environmental exposure and other long-standing inequalities can all contribute.
Women face another awareness problem. Heart disease is the leading cause of death for women as well as men, but many women do not recognize it as their greatest health threat. Symptoms can include chest discomfort, but some women also experience shortness of breath, nausea or unusual fatigue.
Lifestyle can still make a meaningful difference even when other risks are present. Exercise helps the heart and blood vessels work more efficiently and can improve blood pressure, weight and overall fitness. Healthy eating can also support better cholesterol and blood pressure levels.
Stress deserves attention because it can affect the body directly and change daily behavior. Someone under constant stress may sleep poorly, exercise less or rely more heavily on unhealthy foods, cigarettes or alcohol. These patterns can gradually increase cardiovascular risk.
For many adults, the most useful first step is not an expensive test or complicated program. It is simply knowing their blood pressure and cholesterol numbers. A routine visit with a primary care clinician can identify problems that may otherwise remain hidden.
People who already have high blood pressure or heart disease may need more than lifestyle changes. Medicines can be essential for controlling blood pressure, cholesterol or other risks, and treatment should be matched to the individual. Diet and exercise are valuable partners to medical care rather than replacements for prescribed treatment.
A major strength of the current evidence is its focus on prevention at several levels. It shows that heart disease is influenced by personal habits, medical conditions, inherited risk and the environment in which people live. That broader view can help health systems design prevention programs that are more practical and fair.
There are also limits to what these figures can tell us. Large population studies can reveal patterns, but they cannot determine an individual person’s future risk with certainty, and social factors often overlap in complicated ways. Statistics about differences between groups should therefore be used to improve prevention and access to care, not to assume that every person in a group has the same risk.
The overall message is straightforward: heart disease often develops long before it announces itself. Checking blood pressure and cholesterol can reveal hidden risks early, when there is more opportunity to act. Better prevention will require both individual action and wider efforts to make healthy food, safe places to exercise and good medical care easier for everyone to access.
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Source: Rutgers University.
