What is the blood pressure?
The normal blood pressure is 120/80. The numbers are measured in millimeters (mm) of mercury (Hg) and are expressed as a systolic pressure (top number) over a diastolic pressure (bottom number). And hypertension is the medical term we use for high blood pressure. We call it systolic hypertension if the systolic pressure is >140 mm Hg or diastolic hypertension if the diastolic pressure is >90 mm Hg.
In the outpatient setting, the blood pressure is usually measured in the arm using a blood pressure cuff. It’s important to remember that the blood pressure is not completely constant, but rather fluctuates during the day according to activity. Frequent measurement of the blood pressure will help to find the “typical” blood pressure for any individual.
The blood pressure typically rises with patient age. There is usually a continuous rise in systolic blood pressure throughout life. The diastolic pressure usually increases until the 50’s, then levels off, and potentially falls later in life.
How common is high blood pressure?
Hypertension is the most common medical problem in the United States. Defined as a blood pressure of 140/90 mm Hg or greater, and including individuals who take blood pressure medication, nearly 65 million Americans (about one third of the population) have hypertension. And another 25% of Americans have “pre-hypertension,” a systolic blood pressure of 120-139 mm Hg or a diastolic blood pressure of 80-89 mm Hg.
Why is high blood pressure bad?
It turns out that, independent of any other risk factors you might have, high blood pressure is associated with an increase in future heart attack (myocardial infarction [MI]), heart failure, stroke, and kidney disease. In fact, for each increase of 20 mm Hg in the systolic blood pressure or 10 mm Hg in the diastolic blood pressure, there is nearly a doubling of the risk of mortality for heart disease and stroke. It’s pretty sobering.
Treatment of high blood pressure
For individuals with no other medical problems (completely healthy otherwise), the goal of treatment is to lower the blood pressure to 140/90 mm Hg. For individuals with any adverse risk factors (diabetes, chronic kidney disease, coronary artery disease, carotid artery disease, peripheral arterial disease, aortic aneurysm, history of smoking, or elevated blood lipids), the goal of treatment is to lower the blood pressure to 130/80 mm Hg.
For all individuals with hypertension, one focus should be on lifestyle modifications that may foster a lower blood pressure. This would include a prudent diet with reduced saturated and total fat intake and reduced salt intake; physical exercise; weight reduction in patients who are obese or overweight; and moderation of alcohol intake. Vigorous attention to these measures may be sufficient in some individuals to lower the blood pressure to the target range.
Most individuals with hypertension will need medications to lower the blood pressure. And there are a great many medications available for this purpose. It’s impossible to generalize here about which particular medications will be most helpful in any individual patient. It’s important to work with your physician to find the best medicine (or combination of medicines) to treat your hypertension effectively. Athletes may want to avoid beta-blocker medications which blunt the heart rate response to exercise.