Is High Blood Pressure Genetic?

What’s race got to do with high blood pressure?

Hypertension rates vary greatly across racial groups. Black Americans, for example, are more likely to have high blood pressure than U.S. adults of any other race. Nearly 60 percent of Black adults in the U.S. have hypertension, while just under half of white (47 percent), Asian (45 percent) and Hispanic (44 percent) adults do.

Getty Images

As with families, people of the same race or ethnicity may have similar diets, lifestyles and personal histories. These may explain race-based differences in hypertension risk more than genes do.

Numerous studies have pointed to many other factors, besides genes, that may contribute to the high rates of hypertension among African Americans.

Research suggests that Black people may be more sensitive to salt than other people, meaning that a high-salt diet would have a greater impact on their blood pressure than it might on another person’s blood pressure. This part, Kullo says, could be genetic.

“One theory is that in Africa, the climate is such that you would sweat a lot, so the body had to develop mechanisms to preserve sodium,” he says. “But then when, because of the unfortunate slave trade, people were brought to these temperate, colder climates, they still had this tendency to retain sodium and so that made them a bit more predisposed to high blood pressure.”

Black people in the U.S. also face many social, economic and environmental challenges that could contribute to high blood pressure. They may be more likely to live in places where they can’t access healthy food or to live in neighborhoods or work hours that aren’t conducive to getting out and exercising. They may also have more hurdles to accessing basic health care, including routine blood pressure checks.

A 2020 study of 1,845 Black American adults in the journal Hypertension linked experiences of discrimination to increased risk for high blood pressure.

Higher rates of hypertension in Black Americans, Kullo says, “may be, to a large degree, the environment, like stress, structural racism, air pollution and other environmental factors, but there may be some genetic component.”

Does your sex affect your risk?

High blood pressure can look very different in men and women.

Overall, more men have it than women. About 52 percent of adult men have high blood pressure, while just under 43 percent of women do. Men tend to develop high blood pressure earlier than women do, but women’s risk increases more steeply with age. By age 60, women catch up to men, and hypertension rates for the two sexes are about the same.

A great deal of research suggests that women are more sensitive to salt than men. That is, a high-sodium diet would be more likely to lead to hypertension in a woman than in a man. This is the case in women of all ages, but menopause seems to make salt sensitivity worse and salt-sensitive high blood pressure even more common, suggesting that female sex hormones may keep salt sensitivity and blood pressure somewhat under control.

Hormone changes in women may play a significant role in blood pressure.

For example, Cho says, “Some women who’ve never had high blood pressure develop it while they’re pregnant. Pregnancy is like a stress test for the heart.”  How a woman’s body responds to the stress of pregnancy might provide a glimpse of how her body will respond to other stressors or changes later in life. Experts are beginning to recognize that gestational hypertension, or preeclampsia, is not simply an isolated event.

“Women who’ve had high blood pressure during pregnancy are at increased risk for high blood pressure later on in life and also increased risk for having heart disease later on in life,” Cho says.

Women who had preeclampsia should get regular blood pressure checks throughout life.

Women’s bodies may be more sensitive to high blood pressure overall. What’s considered a safe and normal blood pressure may be lower for women than for men.

A 2021 study of 27,000 adults in the journal Circulation found that women face risk for complications from high blood pressure, such as heart attack, heart failure and stroke, when their systolic blood pressure (the number on top) is over 110. For men, the threshold is 120.

Getty Images

What can you do to lower your blood pressure?

You can’t change your genes, but luckily, the things that you can change likely have a much bigger impact on your risk for high blood pressure.

“If you have genetic risk, it doesn’t mean you are destined to have high blood pressure,” Kullo says. “You can reduce your risk through lifestyle, for example, by avoiding weight gain, sedentary behavior, and excessive salt and alcohol.”

According to the American Heart Association, a few key lifestyle changes can go a long way to keeping your blood pressure in check:

• Don’t smoke or vape. Smoking may make high blood pressure worse and harder to treat. Almost immediately after quitting, a smoker’s blood pressure begins to return to a healthier level.
• Eat a heart-healthy, low-sodium diet. The DASH (dietary approaches to stop hypertension) diet is proven to lower blood pressure, but simply following national guidelines for a healthy diet is beneficial, too. To keep your blood pressure where it is, the American Heart Association recommends no more than 2,300 mg of sodium per day. But, ideally, if you already have high blood pressure, you should limit it to 1,500 mg per day. You can start by cutting down from wherever you are. Cutting 1,000 mg per day will already start to lower your blood pressure.
• Get regular physical activity. The CDC recommends that adults get 150 minutes — or 30 minutes a day, five days a week — of moderate-intensity activity every week. But, Cho says, it’s important that you’re moving all day, not just during a 30-minute bout of exercise. “That non-exercise-related motion, we know that’s very important,” she says. “Forget just the time that you exercise at the gym. Throughout the day you should be moving.”
• Reach and maintain a healthy weight. “In America, the number one risk factor [for high blood pressure] is weight — weight and diet, which are all related,” Cho says. If you’ve got some pounds to shed, regular physical activity and a healthy diet will help you get there.
• Cut back on alcohol. Routinely having more than three drinks in one sitting can lead to high blood pressure. Women should limit drinks to one a day; men should stop at two.
• Get sleep disorders under control. Sleep apnea is a known cause of high blood pressure. If you snore, have been told you gasp for air when you sleep, or wake with dry mouth or a headache, ask your doctor if you could have sleep apnea.
• Take your medicine. If you already have high blood pressure and your doctor prescribes medicine to keep it down, take it.

“Nearly half of adults have hypertension, but only 1 in 4 have it under control,” Cho says. “Everybody is afraid of medicine, but what they should be afraid of is all the things that uncontrolled high blood pressure can cause.... The goal of therapy is that you live longer and have a higher quality of life.”