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  • Writer's pictureAlan Frischer, MD, MPH


The following happens frequently: I surprise a generally healthy patient with the news that their blood pressure numbers just aren’t good enough – even when those same numbers were perfectly acceptable in the past. What makes the conversation harder is it that often the patient feels just fine. What is the latest on hypertension?

Let’s review: Blood pressure is recorded in two numbers. Systolic blood pressure (the first and higher number) indicates how much pressure blood exerts against the artery walls when the heart is contracting. Diastolic blood pressure (the second and lower number) indicates how much pressure blood exerts against the artery walls while the heart is resting between beats. It is measured in millimeters of mercury, as this was used in the first accurate pressure gauges and remains the standard today.

Which number is more important? While more attention is given to the systolic (larger) number as a major risk factor for heart disease, a rise in either the systolic or diastolic blood pressure may qualify you for hypertension. For those of us aged 40 to 89, the risk of death from ischemic heart disease and stroke doubles with every 20mm mercury rise above normal for systolic blood pressure, or every 10mm mercury for diastolic blood pressure. Note that systolic blood pressure rises steadily with age, due to the increasing stiffness of large arteries.

Not too long ago, normal blood pressure was considered to be 140/90 or below. This has changed significantly over the years, due to the many studies on heart disease and stroke. According to the American Heart Association, the current standards for blood pressure are:

Normal: Systolic is less than 120 and diastolic is less than 80

Elevated: Systolic is 120 – 129 and diastolic is less than 80

High blood pressure Stage 1: Systolic is 130 – 139 or diastolic is 80 – 89

High blood pressure Stage 2: Systolic is 140 or higher or diastolic is 90 or higher

Hypertensive crisis: Systolic is higher than 180 and/or diastolic is higher than 120

Normal blood pressure means that your particular balance of diet, exercise and genetics is working just fine. At the elevated level, you are likely headed for high blood pressure, and now is the time to take steps to correct it. At Stage 1, your doctor will likely recommend lifestyle changes. At Stage 2, your doctor will likely start you on a combination of blood pressure medications along with lifestyle changes. At the hypertensive crisis stage, you need immediate medical attention. And, if you are experiencing symptoms such as chest pain, shortness of breath, back pain, numbness or weakness, changes in vision, or difficulty speaking, call 911 immediately.

There are many causes of hypertension. The most important contributors include getting older, a high salt diet, sleep apnea (especially untreated), obesity, a sedentary lifestyle, drinking excessive amounts of alcohol, using recreational stimulant drugs like cocaine, amphetamines, or crystal methamphetamine, a diet high in sugars and fat, smoking cigarettes, chronic kidney disease, nutrient deficiencies (especially potassium and vitamin D), thyroid diseases (both overactive or underactive), diabetes mellitus, some birth control pills, stress which stimulates your adrenal glands to pump out excess cortisol…and of course, genetics.

What can you do to help prevent or minimize high blood pressure? Plenty! Start by reducing the salt in your diet. This is hard to do; our country loves to add way too much salt to most processed foods. But certain foods are the low hanging fruit, so to speak - like fast food, processed foods, canned foods, frozen foods, snack foods, and most restaurant foods. Start with fresh food and make it yourself. Use other spices instead of salt. Add some exercise to your daily routine, cut back on your use of alcohol, stop your use of recreational drugs, lose some of those extra pounds, and work hard on how you handle stress.

I urge you to consult your doctor and continue to monitor your blood pressure. This is one of the easy conditions to detect, and there are a number of different medications available to bring your numbers down. Hypertension is the leading cause of cardiovascular disease and death. Untreated high blood pressure can be fatal – don’t ignore it!

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