- Gregg M. Yamada, MD FACC
What Should My Blood Pressure Be?
There is a lot of confusion about ‘what is the optimal blood pressure’.
There shouldn't be. It's simple. Keep your blood pressure under 120/80.
Take your blood pressure readings morning and night and record the top number (systolic), the bottom number (diastolic) and your HR.
If you have been consuming too much salt, alcohol, caffeine; taking steroids, decongestants, nasal sprays, NSAIDs; missing medications, gaining weight, not getting enough sleep, under increased stress--your blood pressure readings may be high. Speak with your PCP about lifestyle and medication changes. Be compliant with your medications.
Definition of Hypertension
Blood pressure over 130/80 = Hypertension
Blood pressure under 120/80 = Normal
A good reference for you to read is the 2017 ACC/AHA Hypertension Guidelines
Hypertension (high blood pressure) is the #1 risk factor for developing a stroke. Most people are unaware that the optimal systolic blood pressure (SBP or ‘top number’) in 2019 is under 120mmhg. In fact, doctors have known that SBP 115mmhg is the ideal number for many decades. It was not until 2015 that a proper study was performed comparing SBP 140mmhg vs SBP 120mmhg. This was known as the SPRINT trial. Prior to this we had only observational data. The SPRINT trial enrolled over 9000 pts with blood pressure over 130mmhg. (If you think about it, most people would be ecstatic if they had a blood pressure of 130!). The SPRINT trial demonstrated that if you lower the SBP <120, you reduce your chances of stroke (CVA), heart failure (CHF), heart attack (MI) by 25% and cardiovascular death by 27%!
My Approach To Managing Blood Pressure: Education
If you have high blood pressure (hypertension), you need to lower it. Sounds obvious right? Not really, because > 75 million people have hypertension. Your initial goal will be to lower your blood pressure (systolic) to <130mmhg. Then under 120/80mmhg if you can tolerate this.
Your approach should never be to tell your doctor 'I don't want to take any medications for my high blood pressure.'
Rather, become educated on ‘how doctors manage blood pressure’. (The 3 mechanisms which doctors use to control hypertension).
Your doctor will discuss the difference between primary and secondary hypertension. The causes of both types of hypertension and the diagnostic tests used in evaluating for these conditions.
With this knowledge, you will know: 1. How each medication works. 2. How to distinguish between a side effect vs an anticipated effect. 3. How medications are ‘layered’ in order to achieve optimal blood pressure lowering. 4. How simple lifestyle changes: getting more sleep, drinking less caffeine and alcohol, eating less sodium, exercising to lose weight…will lower BP with or without medications.
What To Do if You Obtain A High Reading on Your Blood Pressure Monitor at Home
Many people take their blood pressure on a weekend and wonder what they should do if the number is high. Discuss this scenario with your own physician as each will have their own recommendations.
For my patients, I recommend the following:
If your blood pressure is consistently >130mmhg but < 170mmhg, then schedule an appointment with your PCP.
If your blood pressure is > 170mmhg but < 180mmhg and you have repeated the reading after 15 minutes, then present to an urgent care as new medications may be required. You will then follow up with your PCP.
If your blood pressure is > 180mmhg, present to the ER. This may be a hypertensive urgency/emergency.
If you have any symptoms: HA, Chest pain, Palpitations, Shortness of breath, Dizziness, Visual problems, Weakness/incoordination--present to the ER regardless of your blood pressure reading.
Which Doctor Should Manage Your Blood Pressure
Your PCP (primary care physician). My opinion: if two doctors are managing your blood pressure--it is one too many. This is because there are many correct variations/combinations of medications and dosing regimens which are available to your physician and you may end up in a 'push me-pull you' scenario. Your PCP will manage your blood pressure and consult other specialists if required.
Gregg Yamada MD
Note: Understanding your heart condition is not difficult. Patients become frustrated and confused when doctors don’t explain things clearly. If you don’t understand what your doctor is talking about, then you won’t be able to ask meaningful questions. I hope that my posts provide you with a framework that you can build upon to become an active participant in your healthcare.
Disclaimer: These posts are intended for my patients (and others) as educational. I hope you find my medical blogs to be pertinent, interesting, thought provoking, and even humorous. The information provided on this website and in these blogs and online, is educational and should not be taken as medical advice. I am a doctor, but I am not your doctor. Schedule an appointment with your doctor to determine what is right for you.
© 2022. Gregg M. Yamada, MD FACC. All rights reserved