When to Worry About Your Blood Pressure

illustration of an arm getting blood pressure taken

If you’ve been following the news, you know that there’s some hype about the new blood pressure guidelines that were just released by the American College of Cardiology/American Heart Association (ACC/AHA). Under their new, more stringent guidelines, a significantly greater number of people will be diagnosed with hypertension than before. According to the New York Times, the number of men under age 45 who will be diagnosed will now triple and for women double.

New High Blood Pressure Threshold

Currently, most adult blood pressure goals have been set to below 140/90. But according to new guidelines, the cut off will be much lower at 130/80.

Before you frantically search for your long lost and forgotten blood pressure monitor, let’s learn a little more about what blood pressure even is and why the changes have been made.

What is Blood Pressure?

You may have wondered what blood pressure really is even measuring, and why there are two different numbers?

Think of your blood vessels as tiny little hoses. Systolic blood pressure, which is the top and higher number of the two, measures the pressure within these lumens when the heart is contracting (i.e. beating). And the diastolic blood pressure is the bottom, lower number, and reflects the pressure within these walls of the arteries when the heart is relaxing (in between the beats). So for instance, 130/80 means a systolic pressure of 130 and a diastolic pressure of 80.

Which one is more important? Well, they both are, and an elevation in either number is sufficient for a diagnosis. But systolic blood pressure is the one that most people often have trouble with, especially as we grow older. With the aging process, plaques and cholesterol build up in the lining of these “hoses,” thereby “stiffening” them. And this stiffening increases the pressure within, namely the systolic pressure. It’s the one that’s been most associated with heart disease risk.

Why Should We Care About Our Blood Pressure?

So what’s the big deal about these numbers? Why should you care? After all, you feel great. You don’t feel any different even though your blood pressure may be a little (or a lot) high. So why should you even consider taking a pill every day when you don’t have any symptoms?

Well, heart disease and stroke is the number one killer of men and women, not just in the United States, but now in the world. And high blood pressure is one of the most preventable risk factors, as are smoking, diabetes, and high cholesterol. There are other risk factors you may not be able to change, like your family history, age, or sex. Doctors care about the blood pressure a lot because it’s one of those risk factors that we actually have control over, and we can save lives by treating it.

How do elevated blood pressures actually cause damage? Well, if the pressure is high enough in the lumen of the hose, it can eventually cause wear and tear on the wall lining. We have an immune system which is trained to “patch things up.” As a result, platelets, plaques, and cholesterol deposits attack these worn out areas in an attempt to repair and if the lining is thickened enough it can prevent the blood to flow. And we need blood to carry oxygen to our heart, brain, and organs. So if it doesn’t, then those organs are in trouble.

This is why heart disease is referred to as the “silent killer”—because you may feel fine, until one day a heart attack or stroke occurs.

The earlier and more diligently the blood pressure is managed, the less damage we cause to our arteries through time.

Now back to the new study guidelines released. The earlier and more diligently the blood pressure is managed, the less damage we cause to our arteries through time. And according to the new guidelines, those with a higher risk of heart disease need to set a lower blood pressure threshold and consider medications to treat it earlier.

What does “higher risk” mean—how much risk are we referring to? Well, the expert committee answered this question, too. Those with a 10% or greater risk of developing heart disease in the next 10 years should have a 130/80 threshold to consider treatment. Here’s a blood pressure calculator developed by the American Heart Association to individualize this to each person. The more risk factors you have (for instance, the older your age, or the higher your cholesterol), the higher your 10-year risk is. Those that have a 10-year risk of less than 10% may not need medication to treat early on, but should at minimum implement lifestyle changes.

How to Reduce High Blood Pressure

Studies have shown the following:

  • Aerobic exercise reduces systolic blood pressure by 4-9 mm Hg and diastolic by 2-3 mm Hg
  • Weight loss reduces BP by 5-20mmHg
  • Limiting sodium intake reduces BP by 2-8 mmHg. A daily salt intake of less than 2400 mg/day is recommended.
  • For those over age 60: weight loss and reduced salt intake are particularly beneficial

Check out my prior article on how to treat your blood pressure without medication. For some, especially if you have borderline or mildly elevated numbers, making some lifestyle changes alone, such as losing at least 10% of your body weight, may be just sufficient to reach your blood pressure goal. Hence, you may be able to avoid having to take a pill every day.

Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.