Was talking to someone today that for over a decade we both had the same experience of being told "it's a little high" at the doctor's office, with no further discussion on what to do, or the significance of that mildly elevated BP going on for years. And since you don't "feel" it, you don't realize you're spending health points you can't get back, that could've been easily be preserved.
If you're lucky enough to have access to one of the few, elite, specialists in the field of of preventative cardiology, if you have even the lowest degree of hypertension (above 130/80), that's been going on for 6 months or more, besides immediate treatment to bring it down, they start with a baseline "end organ damage assessment", including heart, liver, kidneys, eyes, because there will be at least low levels of detectable damage,
I'm certain that in a decade or two "baseline end organ damage" assessments for anyone with hypertension will be common.
Not because anything special can be done for that early stage of organ injury, but showing patients steady degradation of their organs may be the only way to get them to take BP as seriously as they should.
Yeah, I was going to follow up on my sentence with another one but got called away. I'm specifically reacting to any type of justification for carrying substantially elevated blood pressure for people below 50. The OP is going to fuck himself up if he doesn't fix it. The heart rate may or may not be an issue -- the healthy range is surprisingly high. But that kind of BP really is a time bomb.
Low-level hypertension turns out to be the focus of an incredibly large amount of research and in many instances it's not quite clear how to best treat it. That's one reason for varying guidelines on what actually constitutes meaningful hypertension -- medical organizations in the US have tended to consider 120/80 the highest acceptable blood pressure, whereas many organizations in Europe have opted for slightly higher thresholds, so something like 130/85.
It is certainly true that the threshold for acceptable blood pressure varies by person, and not knowing the context, I would imagine that's what doctors are reacting to when they see mildly elevated pressure but don't pursue it. It's the same way that we all know the safest amount of drugs to take is zero, but there is some non-zero amount that is also safe. If you're in the business of making sure people don't have blood pressure issues, erring low is the default.
In the context of older adults, things get much trickier and more interesting. In the last ten or so years, there has been a great deal of study around the question, "if a patient has X condition, what is the best target blood pressure?" There's an avalanche of papers in that vein where X is nearly every chronic condition and condition associated with advanced age that you can imagine.
Kidney conditions are taxed by most volume depletion medications, so that's a question of organ safety. But for most other conditions, the question is more about the possible side effects from medications. If you take an 80 y.o. and put them on enough meds to get their blood pressure from 170/95 to 120/80, you can bet they're going to have postural orthostasis and disorientation when they stand up and bend over. You're not doing anyone a favor if you break their fucking hip, right?
So the question is, over the course of (say) a decade, will more 65 y.o. people experience medical issues from having a blood pressure of 130/80 *or* have complications from the medications required to drop their BP. The answers have seemed to vary based on the comorbid conditions, making it a still-harder question to answer.
But anyone below fifty who has chronically elevated blood pressure should take the time to trial low doses of one of the dozens of medications. There will be one that is effective with essentially no deleterious (or maybe even noticeable) side effects. It's money and time, but it's better than even low level organ damage from accommodating too much pressure for several decades.
