High blood pressure is called the "silent killer" because it often has no symptoms but can lead to heart disease, stroke, kidney damage, and dementia. Here's what you need to know about monitoring and managing your blood pressure.
Blood pressure measures how hard your blood pushes against the walls of your arteries when your heart pumps. Your arteries are blood vessels that carry blood away from your heart to other parts of your body. Each time your heart beats, it pumps blood through your arteries.
Hypertension is simply the medical term for high blood pressure. High blood pressure typically has no symptoms—which is why it's called the "silent killer"—so getting tested is the only way to know if you have it.
How Common Is High Blood Pressure?
High blood pressure is extremely common in the United States:
Nearly half of all U.S. adults (48.1%, or about 120 million people) have high blood pressure
Prevalence increases with age: 23% for ages 18–39, 53% for ages 40–59, and 72% for ages 60 and older
Men (51%) have higher rates than women (45%)
About 1 in 5 adults with high blood pressure don't know they have it
In 2023, high blood pressure was a primary or contributing cause of 664,470 deaths in the United States
High blood pressure costs the U.S. healthcare system about $131 billion annually
Important: North Carolina is among the states with the highest hypertension prevalence in the country, along with neighboring Southern states.
Your blood pressure reading has two numbers:
Systolic pressure (top number): The pressure in your arteries when your heart beats
Diastolic pressure (bottom number): The pressure in your arteries between heartbeats when your heart is resting
Blood pressure is measured in millimeters of mercury (mm Hg). A reading is written as systolic/diastolic—for example, 120/80 mm Hg (often said as "120 over 80").
The American Heart Association and American College of Cardiology released updated blood pressure guidelines in August 2025—the first major update since 2017. The blood pressure categories remain the same:
Category | Reading | What It Means |
Normal | Less than 120/80 mm Hg | Maintain healthy lifestyle habits |
Elevated | 120–129 / less than 80 mm Hg | Likely to develop hypertension without lifestyle changes |
Stage 1 Hypertension | 130–139 / 80–89 mm Hg | Lifestyle changes; medication may be needed based on cardiovascular risk |
Stage 2 Hypertension | 140/90 mm Hg or higher | Lifestyle changes plus medication typically needed |
Hypertensive Crisis | Higher than 180/120 mm Hg | Seek medical attention immediately |
NEW in 2025 Guidelines: The updated guidelines emphasize earlier treatment, stronger brain health protections, and new risk assessment tools:
PREVENT™ Risk Calculator: A new tool to predict 10-year and 30-year cardiovascular disease risk, helping doctors personalize treatment plans
Brain Health Connection: Research now confirms high blood pressure is linked to cognitive decline and dementia—early treatment can help protect brain health
Target Goal: A blood pressure target of less than 130/80 mm Hg is recommended for most adults to reduce the risk of heart disease, stroke, and cognitive decline
Home Monitoring: Increased emphasis on home blood pressure monitoring combined with team-based care
Your doctor will typically check your blood pressure during routine visits. If you haven't seen a doctor recently, here are the general recommendations:
Ages 18–40 with normal blood pressure: Check every 2–3 years
Ages 40 and older: Check at least once a year
High risk for hypertension: Check at least once a year, regardless of age
Diagnosed with hypertension: Monitor regularly at home as recommended by your doctor
Several factors can increase your risk for developing high blood pressure:
Age: Risk increases as you get older (72% of adults 60+ have hypertension)
Race: Black adults have significantly higher rates (58%) compared to white (49%), Asian (45%), or Hispanic adults (39%)
Family history: Having family members with high blood pressure
Weight: Being overweight or having obesity
Physical inactivity: Not getting enough regular exercise
Diet: Eating foods high in sodium and low in potassium
Tobacco use: Smoking or using tobacco products
Excessive alcohol: Drinking too much alcohol
Other conditions: Having diabetes, chronic kidney disease, or certain heart conditions
Pregnancy: Being pregnant or having a history of high blood pressure during pregnancy
High blood pressure is the #1 preventable risk factor for cardiovascular disease. The longer it goes uncontrolled, the more damage it can cause. Complications include:
Heart Attack and Heart Disease: High blood pressure causes hardening and thickening of arteries (atherosclerosis), reducing blood flow to your heart
Stroke: Blood vessels supplying the brain can burst or become blocked, causing severe disabilities or death
Heart Failure: The heart has to work harder to pump blood, causing hthe eart muscle to thicken and eventually struggle to meet the body's needs
Kidney Disease or Failure: Damaged blood vessels in the kidneys can prevent them from filtering blood properly
Cognitive Decline and Dementia: High blood pressure can damage small blood vessels in the brain, reducing blood flow and increasing risk of vascular dementia (NEW emphasis in 2025 guidelines)
Vision Loss: Blood vessels in the eyes can become thickened, narrowed, or torn
Aneurysm: Weakened blood vessel walls can bulge and potentially rupture—life-threatening if it occurs
Metabolic Syndrome: High blood pressure is one factor in this syndrome that increases the risk of heart disease, stroke, and diabetes
Sexual Dysfunction: Can lead to erectile dysfunction in men and reduced sex drive in women
Lifestyle changes are the first-line treatment for all levels of high blood pressure. These strategies can help prevent, lower, or control blood pressure:
Follow the DASH Diet: Emphasizes vegetables, fruits, whole grains, legumes, nuts, low-fat dairy, and lean proteins while reducing saturated fat and added sugars
Reduce Sodium: Aim for less than 2,300 mg per day, ideally moving toward 1,500 mg (about 2/3 teaspoon of salt)
Exercise Regularly: At least 150 minutes per week of moderate-intensity aerobic activity
Maintain a Healthy Weight: Even modest weight loss can help lower blood pressure
Limit Alcohol: No more than 1 drink per day for women, 2 for men
Quit Smoking: Tobacco raises blood pressure and damages blood vessels
Manage Stress: Chronic stress can contribute to high blood pressure
Get Adequate Sleep: Poor sleep can affect blood pressure
Blood Pressure Screening:
Medicare Part B covers blood pressure checks at no cost to you during your:
"Welcome to Medicare" Preventive Visit: Available within your first 12 months of Part B enrollment—includes blood pressure measurement, height, weight, BMI, and a written prevention plan
Annual Wellness Visit: Available every 12 months after your first year on Medicare—includes blood pressure check as part of developing or updating your personalized prevention plan
You pay $0 for these preventive visits if your provider accepts Medicare assignment. The Part B deductible doesn't apply. However, if your doctor performs additional tests or services during the same visit that aren't covered as preventive care, you may have to pay coinsurance and meet your deductible.
Ambulatory Blood Pressure Monitoring:
If your doctor suspects "white coat syndrome" (elevated blood pressure due to anxiety in medical settings), Medicare Part B may cover ambulatory blood pressure monitoring once per year. You'll wear a device that takes multiple readings over 24–48 hours.
Hypertension Treatment:
Medicare Part B covers medically necessary doctor visits and outpatient tests to diagnose and manage hypertension. After meeting your Part B deductible ($257 in 2025), you typically pay 20% of the Medicare-approved amount.
Blood Pressure Medications (2025-2026):
Original Medicare (Parts A & B) does NOT cover prescription medications you take at home. To get coverage for blood pressure medications, you need:
Medicare Part D: A stand-alone prescription drug plan that covers medicines like lisinopril, losartan, amlodipine, metoprolol, and other common blood pressure drugs
Medicare Advantage with Part D: Many Medicare Advantage plans include drug coverage
NEW for 2025: Medicare Part D now has a $2,000 annual out-of-pocket cap. Once you reach this limit, your plan pays 100% of covered drug costs for the rest of the year. You can also use the Medicare Prescription Payment Plan to spread costs over the year instead of paying everything upfront.
2025 Part D Costs:
Maximum deductible: $590
Average premium: ~$47/month
Out-of-pocket cap: $2,000
Tip: Many generic blood pressure medications are on preferred tiers with low or $0 copays. Check your plan's formulary to see how your specific medications are covered.
Home Blood Pressure Monitors:
Medicare Part B generally does NOT cover home blood pressure monitors, with limited exceptions:
Home dialysis patients: Part B covers a manual blood pressure monitor and a stethoscope
Ambulatory monitors: May be covered once per year when prescribed by a doctor (Medicare pays 80% after deductible)
If you need to purchase a home blood pressure monitor, they're available at pharmacies and retailers, typically ranging from $30–$100. Look for validated brands like Omron.
Under the Affordable Care Act, all Marketplace health plans and most private health insurance plans must cover blood pressure screening at no cost as a preventive service. This applies even if you haven't met your yearly deductible.
To access this coverage at no cost, make sure you:
Use a doctor in your plan's network
Schedule the visit as a preventive/wellness exam
Understand that additional tests or treatment during the same visit may incur costs
Private insurance typically covers blood pressure medications through your plan's pharmacy benefit. Coverage varies by plan and medication, so check your formulary for specific drugs and costs. Some plans cover home blood pressure monitors—check with your provider.
If you don't have insurance and don't see a doctor regularly, you can still get your blood pressure checked:
Community health centers and clinics: Often offer free or low-cost screenings
Health fairs: Free blood pressure screenings are common
Pharmacies: Many stores have free blood pressure machines, though accuracy can vary
Home monitors: Purchase your own validated device for regular monitoring
Important: For accurate readings, use the correct cuff size for your arm, sit quietly with feet flat on the floor, and don't talk during the reading. Pharmacy machines may not be calibrated accurately—a home monitor with validated accuracy is preferable for regular monitoring.
At Health Plans of NC, our experienced local health insurance agents can help you understand your options for blood pressure screening, treatment, and medication coverage. We specialize in helping North Carolina residents find the right health insurance plan—whether you need:
Medicare Part D prescription drug coverage for blood pressure medications
Medicare Advantage plans with comprehensive drug coverage
ACA Marketplace plans with preventive care coverage
Individual or family health insurance plans
Whether you're in Charlotte, Raleigh, Greensboro, Durham, or anywhere in North Carolina, we can help you find coverage that fits your health needs and budget.