The Doctors Next Door

What's a Normal Blood Pressure?

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It's the $100,000 question on One Vs One Hundred.  Player, Eric Smart, is growing more emotional as he ascends the greenback ladder.  "What does the Mayo Clinic consider a normal blood pressure?"  I'm sitting there watching with my son and I burst out "Well who doesn't know that?!"  Now my kids do many things for me. Aside from roping me into meaningless television shows, getting me hooked and derailing  my quest to live a productive life, they also keep me connected to the real world.  With just a slight bit of sarcasm, I'm told "Mom--I wouldn't know that, most people wouldn't know that."  Sure enough when the results come in some 15 people in the audience are eliminated. 

 

High blood pressure is THE most common chronic illness in the U.S.  Many of you out there have it, in fact one in three adults has it!  If you're not one of them yourself, a lot of people in your life are. Ergo...you need to know what a normal blood pressure is. Do you even know what your own blood pressure is?  The next time you're at the doctor, make sure you ask. 

 

So what's the answer to the $100,000 questionWhat's a normal blood pressure? 

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Come on, take a guess.

Answer: Normal BP is less than 120/80.
 
As you can see there are two numbers we're looking at here--the first number is call the systolic (120 in our example of normal) and diastolic (80).  Which is most important?  Well that has sure been debated over the years. When I was going through med school, those know-it-all professor types told me the lower number (diastolic) was the most important.  This is another example of one of the things I had to un-learn in later years. (And no--I did NOT get a tuition refund. It just ain't right.)  Well some other know-it-all professor-researcher types have shown that the systolic number may be the most important, but ultimately, they both matter. 

 

So if your blood pressure is 125/85 do you need medicine to bring it down?  Probably not.  You haven't actually reached full-blown high blood pressure (aka hypertension)...yet. You have a condition called "pre-hypertension" which often leads to hypertension.  Here's how the numbers shake out for people age 18 years and older:

 

Category

Systolic

 

Diastolic

Normal 

Less than 120

AND

Less than 80

 

Pre-hypertension

120-139

OR

80-89

 

Stage 1 hypertension

140-159

OR

90-99

 

Stage 2 Hypertension

160 or higher

OR

100 or higher

 

So what's the big deal?  Well, let me assure you, it is a big deal.  Some people mistakenly believe they would feel it if their blood presssure was high and your friends might see

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something like this.

 

Truth is, you can't feel your blood pressure unless it's extremely high in which case you may get headaches, nosebleeds or chest pain. Mostly high blood pressure is a silent disease that wreaks havoc on your vital organs causing strokes, heart attacks, kidney failure and general hardening of the arteries.

 

So what causes high blood pressure?  Most cases are what we call "essential hypertension" which is a sophisticated way that we doctors like to say "Uh...I dunno...".  Let's talk about what we DO know since that's much more within our comfort zone. So here's what we do know:

·       It runs in families

·       Some people have a salt-sensitive type of high blood pressure--not everyone

·       Alcoholic beverages can increase your blood pressure

·       Overweight and obesity contribute to high blood pressure

 

So what do these factors mean to you and your ability to change the course of a diagnosis of hypertension?  Well, for people who are overweight or obese, significant weight loss can make a difference--probably somewhere in the range of 10% of your body weight.  For people with a weight problem and hypertension, it's possible (no promises here) that if you lose enough weight, your blood pressure might go down to normal.  Similarly, if you drink more than a moderate amount of alcohol, and you stop doing that, it may be that your blood pressure will go down to normal. 

 

As far as salt goes, well it may be worth a try in decreasing your intake.  First try to decrease your intake to less than 4 grams of salt a day and if that doesn't work, you may need to decrease to less than 2 grams per day.  There's a dual benefit to this in that such deprivation is also one of the qualifications for sainthood--actually pretty high on the list in fact, right under never using Q-tips to clean out your earwax.

 

Blood pressure can be a problem in kids too and is becoming more common due to our diets and increasing rates of overweight and obesity.  For more information on blood pressure in kids look here

 

There are lots of medicines used to treat high blood pressure.  The most common reasons I've heard to resist going on medication for high blood pressure are:

 

  1. If I go on medicine, I'm afraid I'll become dependent on it and never be able to get off of it.  This isn't the right way to look at the treatment of high blood pressure with medication.  Yes--your blood pressure problem may necessitate that you stay on the medicine "forever", or as I like to say "indefinitely" (people tend to take that better but it's really a euphemism for "forever".) If you are biologically built to have high blood pressure, then in order to decrease your risk of stroke, heart disease, kidney failure and other such bad consequences, then you need medicine to keep your blood pressure in the normal range.  It's just like the diabetic person who needs insulin. 
  2. I don't want to have side effects from the medication.  We have so very many choices of medications to treat your blood pressure that I tell folks that I don't expect them to tolerate side effects.  If side effects happen, sometimes they go away with a little patience but if not, we change medicines!  It's that simple but you'll need to bear with your doctor because it's largely a trial and error process to find the right drug or combination of drugs.

Many people need three or four different medicines to keep their blood pressure in the normal range.  I know it's distasteful to have to take one medicine let alone three or four.  But these medicines can help keep you living, laughing and loving for longer so work with your doctor to get it right for both your personal comfort and the control of your conditions.  And don't forget, nothing replaces living a healthy lifestyle--exercising (once your blood pressure is in the normal range), eating a balanced diet and the occassional dark chocolate. 

 


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