Americans are living longerwhich means more time to do the things we love with the people we care about. But the extended lifespan has a flip side: It entails a greater risk of developing one or more chronic health conditions as we enter older adulthood. One of the most chronic diseases facing older Americans today is high blood pressure (hypertension), which affects almost 70% of people aged 60 and over.¹

Here’s a surprising fact about high blood pressure: More than 40% of adults with this condition don’t even know they have it.¹ The problem is not a lack of concern; it’s a lack of clues. Most people with hypertension feel normal – even though elevated pressure is quietly damaging their blood vessels. This is why hypertension is often called a “silent killer.”

Read on to learn why high blood pressure rarely causes obvious symptoms, what subtle warning signs may be present, and when to seek medical attention.

Why does hypertension often have no symptoms?

High blood pressure-when the force of the blood against your artery walls is consistently too high – does not produce symptoms on its own. Rather this excess pressure builds up slowly over the years, gradually causing small tears in the artery linings. Fat and cholesterol can stick to these damaged areas and accumulate, leading to plaque formation and a narrowing of the vessels. This restricts blood flow throughout your body and puts extra strain on your heart, which has to work harder to pump blood.

What are subtle, silent signs and symptoms of high blood pressure?

Most experience no symptoms at all, making regular screening critical. However, if you have very high blood pressure or a sudden rise, you may notice one or more of the following signs:

1. Headache early in the morning: Persistent, dull headache felt at the back of your skull when you wake up may be related to nocturnal high blood pressure. These headaches are more common when your blood pressure rises rapidly or reaches severe levels.
2. Dizziness or vertigo: High blood pressure can reduce blood flow to your brain and make you lethargic.
3. Blurred vision or eye strain: Your eyes contain delicate blood vessels. Over time, uncontrolled hypertension can damage the retina and cause blurred or double vision and even vision loss. Regular eye exams sometimes reveal high blood pressure before other tests do.
4. Throbbing sensation in your ears, neck or chest: This can be the result of increased pressure from blood flowing through your arteries – especially if you have other symptoms.
5. Shortness of breath: Extra pressure in your blood vessels forces the heart to pump harder, which can cause you to become short of breath easily during physical activities.
6. Nosebleed: Occasional nosebleeds are usually nothing to worry about. But frequent or unexplained episodes may accompany sudden increases in blood pressure. Although not a reliable early sign, repeated nosebleeds warrant a blood pressure check.
7. Fatigue or confusion: Uncontrolled hypertension can impair blood flow to your brain, leading to persistent fatigue, difficulty concentrating, or even episodes of confusion.
8. Irregular heart rhythm (palpitations): High blood pressure can enlarge or strain your heart muscle, contributing to atrial fibrillation or other arrhythmias. This may feel like your heart is fluttering, racing, or skipping beats.
9. Tinnitus: Tinnitus is defined as recurrent ringing, buzzing or roaring in one or both ears. In a 2021 study, researchers found that 45.8% of people with hypertension also had tinnitus (compared to 39.2% of people who did not have hypertension).² While tinnitus has many causes, new or worsening tinnitus is another signal to check your numbers.

Regular blood pressure checks are essential, even without symptoms

Even without symptoms, older adults should have their blood pressure checked at least once a year. “Hypertension can affect anyone,” explained Leigh Simmons, MD, a general internist, in a Mass. Gen. Brigham Newsroom article. “The biggest risk factor for whether you will develop hypertension is your family history of hypertension or high blood pressure.”

The only reliable way to know your blood pressure is to check it routinely. Your doctor may suggest more frequent monitoring if you:

• Have parents, siblings and/or grandparents who have hypertension
• Have repeated readings above 120/80 mmHg
• Live with diabetes, kidney disease or heart problems
• Take medications known to raise blood pressure
• Notice any of the subtle signs described above

Below are some easy ways to keep track of your numbers:

• Annual wellness visits: It is common to have your blood pressure checked at each nursing visit. But if it’s overlooked by your provider, don’t be afraid to ask! You are your own best advocate.
• Home surveillance: Automatic cuff monitors let you track trends in your blood pressure readings—and our testing showed that these are some of the best blood pressure monitors for home use. Record your results in a notebook or smartphone app and share them with your provider at your next visit.
• Pharmacy machines: Many grocery stores or pharmacies offer free walk-up stations. These are perfect for quick checks while shopping or waiting for your prescriptions to be filled.

If your measurements are persistently elevated (above 120/80 mmHg), schedule an appointment with your healthcare provider. Early detection and treatment is your best defense against heart attack, stroke, kidney failure and vision loss.

Frequently asked questions

What are the signs and symptoms of high blood pressure in older adults?
High blood pressure rarely causes pronounced symptoms, which is why it is called a “silent killer.” But some older adults may experience signs that are easy to miss, such as early-morning headaches, blurred vision, dizziness, or fatigue—especially when blood pressure is very high or rising rapidly.

Can high blood pressure make you feel tired or dizzy?
Yes, high blood pressure can sometimes cause fatigue or dizziness, especially if it is very high or fluctuating. These symptoms may also be related to medications or other health conditions, so it is important to discuss them with your healthcare provider.

What should I do if my blood pressure is high but I feel fine?
Even if you feel fine, persistently high blood pressure still increases your risk of heart disease, stroke, and other serious health conditions. Don’t ignore elevated readings – track them and share your results with your doctor.

What are the emergency symptoms of dangerously high blood pressure?
Seek immediate medical attention if you experience symptoms such as chest pain, severe headache, vision changes, shortness of breath, confusion or nausea along with a blood pressure reading above 180/120 mmHg. These can be signs of a hypertensive crisis, which can lead to loss of consciousness, stroke, heart attack and other life-threatening problems.

How often should older adults check their blood pressure?
Older adults should check their blood pressure at least once a year during routine check-ups. If you have elevated measurements or risk factors, your doctor may recommend more frequent checks – either at home, at a pharmacy or during regular doctor visits.

Sources

1. Centers for Disease Control and Prevention. Hypertension incidence, awareness, treatment, and control among adults aged 18 years and older: United States, August 2021–August 2023. October 2024. Found online at https://www.cdc.gov/nchs/products/databriefs/db511.htm

2. Alessandra Giannella Samelli, et al. Hearing loss, tinnitus and hypertension: analysis of baseline data from the Brazilian Longitudinal Study of Health of Adults (ELSA-Brasil). Clinics (São Paulo). 19 Mar. 2021. Found on the Internet at https://pmc.ncbi.nlm.nih.gov/articles/PMC7978663/