Employee & Community Health

Blood pressure: It's about the numbers

5/16/2019 by Dr. Jason Post

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Blood pressure is all about the numbers. And those numbers have changed. Until recently, blood pressure was considered high with a reading of 140/80 or above. But research, which led to the new guidelines, now identifies 130/80 as high blood pressure and healthy blood pressure as 120/80. One result of these guidelines is that more people are being diagnosed as having high blood pressure, allowing their health care teams to intervene sooner. So what does this mean for you?

First, what do these numbers represent?

  • Systolic pressure. This is the higher number, which is the phase of the heartbeat when the heart muscle contracts and pumps blood from the chambers into the arteries. 
  • Diastolic pressure. The lower number is when the heart muscle relaxes and allows the chambers to fill with blood. 

Both are important. High blood pressure can lead to cardiovascular disease, which puts you at risk for a heart attack or stroke. Unfortunately, most people don't know if they have high blood pressure, since there are few symptoms; that's why it's called the silent disease. The best way to find out if your blood pressure is high is to be screened. 

Screening for high blood pressure

Most people should stat having their blood pressure checked at age 40, and every three to five years after that, if they're healthy. Typically, adults have their blood pressure checked whenever they come to the clinic, which helps you and you care team stay on top of your numbers. 

However, if your body mass index (BMI) is over 25, you are African American, or have previously been found to have high blood pressure (above 130/80), you should be checked every year. 

If you're found to have high blood pressure (130/80 or higher) in the office, one of the new guidelines calls for confirming it with readings at home, as well as regularly taking your blood pressure when you're away from the clinic. This is a chronic disease that needs to be managed in real life. 

Managing your condition

The first course of action for managing high blood pressure is making lifestyle changes, either instead of, or in addition to, starting on medication. Losing weight, even just 10 pounds, can have a major impact. The DASH diet, with its emphasis on fruits and vegetables, is one of the most effective approaches for stopping high blood pressure. Increasing exercise and decreasing alcohol consumption helps, too. 

Treatment with medication depends on the stage at which your blood pressure was diagnosed. 

  • Stage 1 (130-139/80-89). Medications are given based on other risk factors, such as heart or kidney disease or diabetes. For many, lifestyle changes may be enough. 
  • Stage 2 (140/90). Medication is recommended for nearly everyone. These fall into four categories: diuretics (chlorthalidone, hydrochlorothiazide); ACE inhibitors (lisinopril); ARBs (losartan); and calcium channel blockers (amlodipine). Studies have shown all are equally effective in reducing blood pressure. At Stage 2, two drugs may be prescribed. 

If you're on medications, it's really important to take them as prescribed; definitely don't stop without consulting your care team. Also, you'll need periodic blood tests to check your levels of electrolytes, which help balance the amount of water and salts in your body. Along with these steps, it's vital to monitor your blood pressure at home, which is the best way to determine the effectiveness of your treatment. 

The other side of high blood pressure is low blood pressure. It's one of the side effects of some of these medications and can cause dizziness and lightheadedness and increase the risk of falls. That's why your prescription will take into consideration your risk for low blood pressure. 

Blood pressure is all about the numbers. But if you keep the numbers in line with healthy guidelines, you greatly reduce the chance of heart attack or stroke. 

Dr. Jason Post is an internal medicine physician in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM) and practices in the Baldwin Building clinic in Rochester. His interests include hypertension, medical education, competency based assessment, point-of-care ultrasound and office-based procedures.