High Blood Pressure (Hypertension) F.A.Q.

What is the right blood pressure?

If you just have high blood pressure, the target is less than140/90. If you have other conditions like heart failure, stroke, diabetes, heart attack, kidney failure etc., the target is less than 130/80. The upper reading is called systolic blood pressure and the lower one is called diastolic blood pressure.

Which is more important, upper (systolic) blood pressure or the lower (diastolic) blood pressure?

Not too long ago, diastolic blood pressure was thought to be more important. Now the consensus is that controlling systolic blood pressure is as important as controlling diastolic blood pressure.

I am 67 years old. What is the normal blood pressure for me?

A few years back, it was thought that increasing blood pressure was a normal accompaniment of growing old. At that time there were formulae that were supposed to help calculate the “right” blood pressure based on your age. The prevailing thought is that blood pressure control to the target stated above is important regardless of the age. We do need to follow a bit of common-sensical approach, however. We do not want medicine to be worse than the disease. So it may not make sense to shoot for perfect blood pressure if you are 90 and chances of side effects from medicines are more than the chances of long term benefits from blood pressure control

What are the symptoms of high blood pressure?

I have some patients who may have headache or other symptoms from high blood pressure. But, it is most commonly a disease without symptoms.

Why treat high blood pressure if it does not cause any symptoms?

High blood pressure may be pounding on your plumbing pipes (arteries) while you have no clue of its presence. It is called a silent killer. Left untreated, it can increase the chances of a heart attack, stroke, heart failure, kidney failure etc.

How do I know that I have high blood pressure?

This can be easily diagnosed with the help of a blood pressure measuring machine. Your health provider can do it. You can buy a machine at the store to do it at home yourself.

What kind of blood pressure measuring machine should I buy?

Go to a store, look at the options available, and see what you are comfortable using. Pay special attention to the cuff size. The machine can give you a wrongly high or low reading if the cuff is too small or too large for your arm size respectively. Have the store personnel help you determine the right cuff size for you. You may have to go to a medical equipment store for certain non-standard cuff sizes.

Is measuring blood pressure at a store like Wal-Mart okay?

There is some concern about accuracy of these machines in the stores. I will propose that you talk to the staff at the pharmacy you shop at and ask them how they calibrate the blood pressure machine that you use there. Some stores may contract out maintenance of public blood pressure measuring machines to outside agencies. If you show interest, they will sure be more interested in assuring maintenance of their blood pressure machines.

Are digital machines as good as those in a doctor’s office?

Now days, digital machines are quite reliable. They have certain limitations. They can give erratic readings if your pulse is irregular due to extra beats or atrial fibrillation. One useful clue: if your heart rate is all over the place during a measurement with a digital machine, the blood pressure measurement will not be reliable. An erratic pulse or blood pressure may also sometime make the important diagnosis of atrial fibrillation. If you notice problems like this, you should talk to your provider.

How frequently should I check my blood pressure?

Except for some uncommon exceptions, do not measure your blood pressure several times a day. Do not let blood pressure numbers take over your life. Remember, blood pressure more commonly hurts your body over months and years and not over days. In most circumstances, measuring blood pressure twice a week should be enough. Try to measure it different times of the day as you want to assure normal blood pressure as close to 24 hours a day as possible. Make sure you write these numbers down as you are unlikely to remember them all after a few readings. Discuss these numbers with your provider.

How do you treat blood pressure?

There are several measures apart from medicines that can be used to lower the blood pressure. These are called non-pharmacological measures. Losing weight, eating less salt and exercising are some of the important measures. The following table is taken from JNC 7 guidelines

Lifestyle Modifications to Prevent and Manage Hypertension*

*For overall cardiovascular risk reduction, stop smoking
**The effects of implementing these modifications are dose- and time-dependent and could be greater for some individuals.

One important reversible cause of high blood pressure is heavy alcohol intake. If you are drinking heavily, just abstinence or moderation may help you stop your blood pressure medications.

As important as non-pharmacological measures are, do not use them as a tool for procrastination. If you are unable to achieve the desired blood pressure level after three or so months of trying, you should consider medicines if prescribed by your provider. You always have the option of stopping the medicines later if you do not need them any more.

Medications are one of the mainstays of treatment. The choice of medicines depends on several factors that need to be evaluated on an individual basis. There are several inexpensive generic medicines available for controlling blood pressure.

What causes high blood pressure?

In most of the cases, there is no discernable cause of high blood pressure. However, diagnosis and treatment of some rare causes like hormonal disturbances and blockage of kidney arteries can be very gratifying. Every blood pressure patient may not need an elaborate work up for a cause of high blood pressure. Certain specific features may prompt your provider to do such a work up.

According to JNC 7 guidelines, some of the discernable causes of high blood pressure are:

• Chronic kidney disease/obstructive uropathy
• Thyroid and parathyroid disease
• Drugs (prescription, over-the-counter, herbal supplement, illicit drugs)
• Excessive alcohol use
• Obstructive sleep apnea
• Primary aldosteronism
• Renal artery stenosis
• Pheochromocytoma
• Cushing's syndrome
• Aortic coarctation
• Obesity

What is white coat hypertension?

This is a phenomenon where a person who does not actually have high blood pressure may show high blood pressure readings in his health provider’s office. Such persons typically do not need any treatment for high blood pressure. You may be found to have high blood pressure whenever you go to your doctor’s office. The only way you can tell whether it is white coat hypertension is by checking your blood pressure at home and documenting normal readings there. Do not presume the diagnosis of white coat hypertension if the only time you check your blood pressure is when you go to see your doctor. Do not use this diagnosis to deny the existence of a problem.

When should I get worried about high blood pressure?

If your blood pressure is consistently above the target as stated above, you should seek medical attention.

High blood pressure along with chest pain, shortness of breath, visual disturbances or other neurological symptoms etc. constitutes a hypertensive emergency. This condition should prompt emergent medical attention.

Why is my blood pressure so hard to control?

You may have noticed that you need much more or much less medicines to control your blood pressure as compared to your spouse or sibling or friend. Sometimes, your provider may need to make frequent medicine adjustments to get your blood pressure under control. Do not get frustrated. Work with your provider as a team to achieve the desired goals. Some of the causes of resistant (hard to treat) hypertension according to JNC 7 guidelines are:

- Improper BP measurement (over inflation of the cuff or using a cuff that is too small for the arm) can lead to inaccurately high readings.

- Brachial arteries may be heavily calcified or arteriosclerotic and cannot be fully compressed (pseudohypertension).

- Clinic or white coat hypertension

- Failure to receive adequate doses of medication (may be reluctance by patient or practitioner)

- Inadequate diuretic therapy

- Drug interactions

I have always had perfect blood pressure. Now my provider says I have high blood pressure. How can that be possible?

A normal blood pressure today is no guarantee against high blood pressure in the future. You can definitely decrease the chances of having high blood pressure by proactively avoiding or managing the risk factors described in a tabulated form above.

When is blood pressure considered too low?

-         In the absence of blood pressure lowering medicines, there are several causes of low blood pressure. If you have dizziness, weakness or any other symptoms with low blood pressure, you should see a doctor. 

-         If you are taking medicines for high blood pressure, there is no point in getting your blood pressure too much below target. If your blood pressure is much below target, your provider may consider lowering your blood pressure medicines.

-         Sometimes, blood pressure lowering medicines may be used for strengthening the heart muscle, e.g., in case of weak heart muscles (cardiomyopathy). In such cases, these medicines may need to be continued despite lower blood pressure. If one starts having symptoms like dizziness, weakness etc. from low blood pressure, your provider may need to consider lowering the medicines.

-         Some research suggests that lowering the lower (diastolic) blood pressure too much may be harmful. This is called J-curve hypothesis. Managing low blood pressure can however be a challenge. If you lower high blood pressure medicines to bring diastolic pressure up, you may end up having high systolic blood pressure.

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