High Blood Pressure
What is the right blood
If you just have high blood
pressure, the target is less than140/90. If you have
other conditions like heart failure, stroke,
diabetes, heart attack, kidney failure etc., the
target is less than 130/80. The upper reading is
called systolic blood pressure and the lower one is
called diastolic blood pressure.
Which is more important,
upper (systolic) blood pressure or the lower
(diastolic) blood pressure?
Not too long ago, diastolic
blood pressure was thought to be more important. Now
the consensus is that controlling systolic blood
pressure is as important as controlling diastolic
I am 67 years old. What is
the normal blood pressure for me?
A few years back, it was
thought that increasing blood pressure was a normal
accompaniment of growing old. At that time there
were formulae that were supposed to help calculate
the “right” blood pressure based on your age. The
prevailing thought is that blood pressure control to
the target stated above is important regardless of
the age. We do need to follow a bit of common-sensical
approach, however. We do not want medicine to be
worse than the disease. So it may not make sense to
shoot for perfect blood pressure if you are 90 and
chances of side effects from medicines are more than
the chances of long term benefits from blood
What are the symptoms of
high blood pressure?
I have some patients who may
have headache or other symptoms from high blood
pressure. But, it is most commonly a
disease without symptoms.
Why treat high blood
pressure if it does not cause any symptoms?
High blood pressure may be
pounding on your plumbing pipes (arteries) while you
have no clue of its presence. It is called a silent
killer. Left untreated, it can increase the chances
of a heart attack, stroke, heart failure, kidney
How do I know that I have
high blood pressure?
This can be easily diagnosed
with the help of a blood pressure measuring machine.
Your health provider can do it. You can buy a
machine at the store to do it at home yourself.
What kind of blood pressure
measuring machine should I buy?
Go to a store, look at the
options available, and see what you are comfortable
using. Pay special attention to the cuff size. The
machine can give you a wrongly high or low reading
if the cuff is too small or too large for your arm size
respectively. Have the store personnel help you
determine the right cuff size for you. You may have
to go to a medical equipment store for certain
non-standard cuff sizes.
Is measuring blood pressure
at a store like Wal-Mart okay?
There is some concern about
accuracy of these machines in the stores. I will
propose that you talk to the staff at the pharmacy
you shop at and ask them how they calibrate the
blood pressure machine that you use there. Some
stores may contract out maintenance of public blood
pressure measuring machines to outside agencies. If
you show interest, they will sure be more interested
in assuring maintenance of their blood pressure
Are digital machines as good
as those in a doctor’s office?
Now days, digital machines are
quite reliable. They have certain limitations. They
can give erratic readings if your pulse is irregular
due to extra beats or atrial fibrillation. One
useful clue: if your heart rate is all over the
place during a measurement with a digital machine,
the blood pressure measurement will not be reliable.
An erratic pulse or blood pressure may also sometime
make the important diagnosis of atrial fibrillation.
If you notice problems like this, you should talk to
How frequently should I
check my blood pressure?
Except for some uncommon
exceptions, do not measure your blood pressure
several times a day. Do not let blood pressure
numbers take over your life. Remember, blood
pressure more commonly hurts your body over months
and years and not over days. In most circumstances,
measuring blood pressure twice a week should be
enough. Try to measure it different times of the day
as you want to assure normal blood pressure as close
to 24 hours a day as possible. Make sure you write
these numbers down as you are unlikely to remember them
all after a few readings. Discuss these numbers with
How do you treat blood
There are several measures
apart from medicines that can be used to lower the
blood pressure. These are called non-pharmacological
measures. Losing weight, eating less salt and
exercising are some of the important measures.
The following table is taken from JNC 7 guidelines
Lifestyle Modifications to
Prevent and Manage Hypertension*
Approximate Systolic Blood Pressure
(SBP) Reduction (Range)**
Maintain normal body
weight (body mass index 18.5-24.9 kg/m2)
5-20 mm Hg/10 kg
Approaches to Stop Hypertension (DASH)
Consume a diet rich in
fruits, vegetables, and low-fat dairy
products with a reduced content of saturated
and total fat.
8-14 mm Hg
Reduce dietary sodium
intake to no more than 100 mmol per day (2.4
g sodium or 6 g sodium chloride).
2-8 mm Hg
Engage in regular
aerobic physical activity such as brisk
walking (at least 30-45 minutes per day,
most days of the week)
4-9 mm Hg
Moderation of alcohol
Limit consumption to no
more than 2 drinks (e.g., 24 oz. beer, 10
oz. wine, or 3 oz. 80 proof whiskey) per day
in most men and to no more than 1 drink per
day in women and lighter-weight persons.
2-4 mm Hg
overall cardiovascular risk reduction, stop smoking
**The effects of implementing these modifications
are dose- and time-dependent and could be greater
for some individuals.
One important reversible cause
of high blood pressure is heavy alcohol intake. If
you are drinking heavily, just abstinence or
moderation may help you stop your blood pressure
As important as
non-pharmacological measures are, do not use them as
a tool for procrastination. If you are unable to
achieve the desired blood pressure level after three
or so months of trying, you should consider
medicines if prescribed by your provider. You always
have the option of stopping the medicines later if
you do not need them any more.
Medications are one of the
mainstays of treatment. The choice of medicines
depends on several factors that need to be evaluated
on an individual basis. There are several
inexpensive generic medicines available for
controlling blood pressure.
What causes high blood
In most of the cases, there is
no discernable cause of high blood pressure.
However, diagnosis and treatment of some rare causes
like hormonal disturbances and blockage of kidney
arteries can be very gratifying. Every blood
pressure patient may not need an elaborate work up for
a cause of high blood pressure. Certain specific
features may prompt your provider to do such a work
According to JNC 7 guidelines,
some of the discernable causes of high blood
Chronic kidney disease/obstructive uropathy
Thyroid and parathyroid disease
(prescription, over-the-counter, herbal
supplement, illicit drugs)
Excessive alcohol use
Obstructive sleep apnea
What is white coat
This is a phenomenon where a
person who does not actually have high blood
pressure may show high blood pressure readings in
his health provider’s office. Such persons typically
do not need any treatment for high blood pressure.
You may be found to have high blood pressure
whenever you go to your doctor’s office. The only way
you can tell whether it is white coat hypertension
is by checking your blood pressure at home and
documenting normal readings there. Do not presume
the diagnosis of white coat hypertension if the only
time you check your blood pressure is when you go to
see your doctor. Do not use this diagnosis to deny
the existence of a problem.
When should I get worried
about high blood pressure?
If your blood pressure is
consistently above the target as stated above, you
should seek medical attention.
High blood pressure along with
chest pain, shortness of breath, visual disturbances
or other neurological symptoms etc. constitutes a
hypertensive emergency. This condition should prompt
emergent medical attention.
Why is my blood pressure so
hard to control?
You may have noticed that you
need much more or much less medicines to control
blood pressure as compared to your spouse or sibling
or friend. Sometimes, your provider may need to make
frequent medicine adjustments to get your blood pressure
under control. Do not get frustrated. Work with your
provider as a team to achieve the desired goals.
Some of the causes of resistant (hard to treat)
hypertension according to JNC 7 guidelines are:
- Improper BP
measurement (over inflation of the cuff or using a
cuff that is too small for the arm) can lead to
inaccurately high readings.
arteries may be heavily calcified or
arteriosclerotic and cannot be fully compressed
- Clinic or
white coat hypertension
- Failure to
receive adequate doses of medication (may be
reluctance by patient or practitioner)
always had perfect blood pressure. Now my provider
says I have high blood pressure. How can that be
A normal blood
pressure today is no guarantee against high blood
pressure in the future. You can definitely decrease
the chances of having high blood pressure by
proactively avoiding or managing the risk factors
described in a tabulated form above.
blood pressure considered too low?
In the absence of blood pressure lowering
medicines, there are several causes of low blood
pressure. If you have dizziness, weakness or any
other symptoms with low blood pressure, you should
see a doctor.
If you are taking medicines for high blood
pressure, there is no point in getting your blood
pressure too much below target. If your blood
pressure is much below target, your provider may
consider lowering your blood pressure medicines.
Sometimes, blood pressure lowering medicines
may be used for strengthening the heart muscle,
e.g., in case of weak heart muscles (cardiomyopathy).
In such cases, these medicines may need to be
continued despite lower blood pressure. If one
starts having symptoms like dizziness, weakness etc.
from low blood pressure, your provider may need to
consider lowering the medicines.
Some research suggests that lowering the
lower (diastolic) blood pressure too much may be
harmful. This is called J-curve hypothesis. Managing
low blood pressure can however be a challenge. If
you lower high blood pressure medicines to bring
diastolic pressure up, you may end up having high
systolic blood pressure.
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