"Your blood pressure is one of the easiest and simplest measurements and can tell you so much about your current and possible future health," says Dr. Randall Zusman, director of the division of hypertension for Harvard-affiliated Massachusetts General Hospital's Corrigan Minehan Heart Center. "Yet most people don't know their number or check it on a regular basis, so they may not be doing everything they need to lower their risk of a heart attack or stroke."
FEELING THE PRESSURE
Blood pressure helps to diagnose hypertension, or high blood pressure. Readings are recorded as two numbers: systolic pressure (when blood pumps out of the heart) and diastolic pressure (when the heart rests between heartbeats).
Blood pressure is measured in millimeters of mercury (mm Hg). The top number is the systolic pressure and the bottom number is the diastolic pressure. In older adults, systolic pressure typically gets the most attention, but controlling both values is important for preventing stroke and heart attacks, says Dr. Zusman.
High blood pressure causes the heart and arteries to work under greater stress. Over time, this strain can damage artery walls and promote the formation of plaque, which can make blood pressure rise even higher and potentially limit blood flow to critical organs, such as the heart, brain, and kidneys. Ultimately, this can trigger a heart attack or stroke. High blood pressure is often called "the silent killer" because you often don't feel like anything is wrong.
But the big question remains: What level of high blood pressure needs treatment? The answer has changed over the years.
In 2017, new guidelines from the American Heart Association, the American College of Cardiology, and nine other health organizations lowered the diagnosis of high blood pressure to 130/80 mm Hg or higher for all adults. The guidelines also redefined the various blood pressure categories to now include normal, elevated, Stage 1 hypertension, Stage 2 hypertension, and hypertensive crisis (see "Blood pressure categories").
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BLOOD PRESSURE CATEGORIES |
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| Blood pressure category |
SYSTOLIC (upper number) |
DIASTOLIC (lower number) |
|
| Normal | Less than 120 mm Hg | and | Less than 80 mm Hg |
| Elevated | 120-129 mm Hg | and | Less than 80 mm Hg |
| High blood pressure: Stage 1 hypertension | 130-139 mm Hg | or | 80-89 mm Hg |
| High blood pressure: Stage 2 hypertension | 140 mm Hg or higher | or | 90 mm Hg or higher |
| Hypertensive crisis (consult your doctor immediately) | Higher than 180 mm Hg | and/or | Higher than 120 mm Hg |
Source: American Heart Association and American Stroke Association.
MAKING CHANGES
This more aggressive approach to blood pressure control can have multiple benefits, according to Dr. Zusman. "Besides the obvious one of further lowering your risk for heart attack and stroke, it can help men be more mindful about their blood pressure and more proactive about improving their overall health," he says. "High blood pressure is something that almost everyone can do something about."
The new guidelines emphasized lifestyle changes as first-line treatment for lowering and managing blood pressure. For instance, numerous studies have found that adopting either the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diet can help reduce your risk of heart disease, stroke, and other cardiovascular diseases.
You also can further lower your blood pressure and other cardiovascular risk factors by limiting salt intake, adopting stress management techniques, getting serious about exercise, and managing your weight.
KNOW YOUR NUMBER
Your first step is to get an accurate blood pressure reading from your doctor. "Most people don't know their number, or can't remember the last time they had it checked," says Dr. Zusman.
If your number is high, discuss with your doctor how to adopt certain lifestyle changes and whether you need medication.
Medications are recommended for most people with Stage 1 hypertension, especially if they have other health issues, such as diabetes, high cholesterol, or obesity, says Dr. Zusman.
If have high blood pressure, check your numbers a few times a week, and consult your doctor if you notice any significant changes -- either high or low, suggests Dr. Zusman.
Home blood pressure monitors are the best way to do this. (Drugstore monitors are not guaranteed to be accurate.) "Using a monitor is an easy way to gauge your progress and also can offer motivation and encouragement to keep up heart-healthy habits," says Dr. Zusman.
The cost of a home monitor can vary from about $40 to $100, but your health insurance may cover some or all of this. Buy a machine with an arm cuff, which is more accurate than a wrist cuff. Also, bring your machine to your doctor's office to compare its reading to your doctor's. Here are some tips on how to use a monitor and ensure a more accurate reading:
- Avoid caffeinated or alcoholic beverages 30 minutes beforehand.
- Sit quietly for five minutes with your back supported and your legs uncrossed before taking a reading.
- Wrap the cuff over bare skin.
- Support your arm so your elbow is at heart level.
- Don't talk during the measurement.
- Leave the deflated cuff in place, wait a minute, then take a second reading. If the readings are close, average them. If not, repeat again and average the three readings.
