Blood pressure: It's about the numbers
5/18/2023 by Jason Post, M.D.
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 has led to new guidelines, which now identify 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 start 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,you should have your blood pressure confirmed with readings at home. You will also need to continue to monitor your blood pressure regularly by taking your blood pressure when you're away from the clinic. This is a chronic disease that needs to be managed by regular monitoring and annual visits to your provider.
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 are the balance of 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.
One side effect of treating high blood pressure is that you can develop low blood pressure. This condition can cause dizziness, lightheadedness and increase the risk of falls. This potential side effect is why it's important to monitor your blood pressure, take your medication as prescribed, and contact your clinician with any side effects that you experience.
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.
Jason Post, M.D., is an internal medicine physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care 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.