Do You Need Medication If You Have High Blood Pressure but No Symptoms?

How do you approach a condition you may not know you have?

That's the question doctors want to help the many Americans living with asymptomatic high blood pressure answer.

Most providers can spot high blood pressure if given adequate opportunities for diagnosis. But a recent clinical review found that many medical institutions lack clear guidance on how to treat asymptomatic high blood pressure. This lack of a unifying protocol can lead to different practices from doctor to doctor.

How Common Is High Blood Pressure With No Symptoms?

Although it’s hard to quantify how many people have asymptomatic high blood pressure, it’s safe to say that the number is very high. One in five adults likely have high blood pressure without knowing it, Kimberly Campbell, MD, a cardiologist at Cardiology Consultants of Philadelphia, told Verywell via email.

Bradley Serwer, MD, Chief Medical Officer and interventional cardiologist at VitalSolution Cardiology, agrees, adding that unless blood pressure is highly elevated or there is already organ damage, there are no symptoms. Blood pressure does tend to rise with age, and certain conditions like diabetes, stroke, coronary artery disease, and chronic kidney disease may warrant lower blood pressure targets.

Most patients find out that they have high blood pressure at a routine checkup, making regular checkups an important part of a healthy lifestyle.

“This is why it’s important to see your doctor even if you don’t feel bad,” Campbell said. “Not all elevations of blood pressure indicate hypertension, though. Blood pressure can be elevated in the setting of stress or acute blood pressure, so any diagnosis requires blood pressure to be confirmed on a second reading on a separate occasion.”

Some people are naturally anxious in any medical situation, which is commonly known as “white coat syndrome.” Serwer said that even blood pressure machines at pharmacies can provide insight, and often in a lower stress situation.

Do You Need Treatment for High Blood Pressure If You Feel Fine?

Even if you feel fine, you need to address your high blood pressure, and the sooner, the better. Campbell said that the time to treat high blood pressure is before symptoms start.

“Symptoms occur when untreated high blood pressure causes damage to other organs in the body,” Campbell said. “By treating it before symptoms develop, individuals can prevent damage to the heart, brain, kidneys, and other organs.”

In addition to organ damage, high blood pressure puts you at a greater risk for heart attack and stroke.

How Asymptomatic High Blood Pressure Is Treated

For those with stage one hypertension, treatment may be as simple as lifestyle changes, like reducing salt intake, starting an exercise program, and lowering stress levels, Serwer said. But if these tactics don’t work, you may be prescribed medication.

Asymptomatic high blood pressure medications tend to be less intense than those for people experiencing symptoms, who tend to require combination therapy.

“The goal in treating symptomatic high blood pressure is to lower the blood pressure far more rapidly in order to protect the suffering organs,” said Serwer. “For asymptomatic people, we try to avoid rapidly dropping blood pressure as this may cause issues with dizziness or fainting.”

He said treating asymptomatic people with first-line medications like thiazide diuretics or calcium channel blockers is more about protecting their organs in the future.

Will Untreated High Blood Pressure Eventually Cause Symptoms?

Although you may not have symptoms, if your blood pressure is elevated, there is continuous damage, which will eventually cause symptoms, said Campbell. The difference is that by the time there are symptoms, the organ damage is done and may not be easily reversed.

Asymptomatic hypertension can also be an indicator of other conditions. Sleep apnea, kidney disease, and adrenal gland disorders may be found after following up on a high blood pressure diagnosis. Screenings for blood pressure often include screenings for these conditions as well.