Which Blood Pressure Number Matters Most The Answer Might Depend On Your Age
Systolic blood pressure is the best way to predict future cardiovascular events and death, irrespective of age, according to new research. But in younger people, diastolic blood pressure could still be important.
Systolic pressure the upper number in a blood pressure reading measures how hard the heart pumps blood into arteries. Diastolic the bottom number indicates the pressure on the arteries when the heart rests between beats.
In recent years, many medical experts shifted their focus to systolic readings when trying to determine the risk of heart problems, but questions lingered about how important diastolic readings really were, said Dr. Michael Hecht Olsen, lead author of a new study published Monday in the American Heart Association journal Hypertension.
To find out more, researchers looked at 26 years of data from 107,599 adults ages 19-97. Participants didn’t start out with cardiovascular disease, but some eventually reached a “cardiovascular endpoint,” which the study defined as stroke, heart attack or death from heart disease.
The study found that for people under 50, diastolic blood pressure readings “provided additional prognostic predictive information,” Olsen said. But the study showed systolic readings were still “a strong predictor of cardiovascular risk independent of age, sex and other cardiovascular risk factors.”
“The study’s finding that diastolic blood pressure may be particularly important in younger people is noteworthy,” Bhatt said.
Which Blood Pressure Number Is Important
Q.When I am monitoring my blood pressure, which number is most important top, bottom, or both?
A. While both numbers in a blood pressure reading are essential for diagnosing and treating high blood pressure, doctors primarily focus on the top number, also known as systolic pressure.
Systolic pressure reflects the force produced by the heart when it pumps blood out to the body, while diastolic blood pressure is the pressure in your blood vessels when the heart is at rest.
Over the years, research has found that both numbers are equally important in monitoring heart health. However, most studies show a greater risk of stroke and heart disease related to higher systolic pressures compared with elevated diastolic pressures. That’s especially true in people ages 50 and older, which is why doctors tend to monitor the top number more closely. The reason for the difference in risk may be related to the force put on the arteries when blood rushes out of the heart.
The American Heart Association now defines high blood pressure as 130/80 mm Hg or higher. The new guidelines recommend you check your blood pressure often, ideally with a home monitor, to help your doctor determine if you need to make lifestyle changes, begin medication, or alter your current therapy.
by Howard LeWine, M.D.
What Is The Ideal Blood Pressure
Blood pressure readings are calculated using one number over another: systolic blood pressure over diastolic. The blood pressure monitor shows measurements in millimetres of mercury, appearing as mmHg. Everyones blood pressure will be slightly different and you would need to discuss with a medical professional as to whats safe for you.
The normal blood pressure range for adults comes in between 90/60mmHg and 120/80mmHg. This means that anything below 90/60mmHg mark constitutes low blood pressure , while anything above 140/90mmHg indicates high blood pressure as this is the threshold where a medical professional would actively monitor your blood pressure.
Knowing these numbers can help make you more aware of your health, and may help you to stay on top of your blood pressure
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Which Is More Important Systolic Or Diastolic Blood Pressure
In the past, your physician may have told you that your diastolic blood pressure number is the one that is more important. In the last few years, however, research has emerged that points to the systolic number as important as well, and perhaps more indicative of damage to your cardiovascular system than the diastolic number.
In a blood pressure reading, the diastolic number is the force of blood against your artery walls while your heart is at rest . The systolic number is the pressure on artery walls while the heart is beating. Your blood pressure reading is normally expressed as the systolic number first and the diastolic number second, 120/80 mmHg, for example.
A reading of 120/80 mmHg to 139/89 mmHg is classified as prehypertension, the point at which blood pressure is becoming too high and beginning to damage arteries. High blood pressure, or hypertension, is any reading at or above 140/90 mmHg.
Ultimately, both systolic and diastolic blood pressure matter. The National Heart, Blood and Lung Institute of the National Institutes of Health defines a patient as having high blood pressure if either systolic or diastolic blood pressure is high.
What Do Blood Pressure Numbers Mean
Blood pressure is measured using two numbers:
The first number, called systolic blood pressure, measures the pressure in your arteries when your heart beats.
The second number, called diastolic blood pressure, measures the pressure in your arteries when your heart rests between beats.
If the measurement reads 120 systolic and 80 diastolic, you would say, 120 over 80, or write, 120/80 mmHg.
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How Does It Change Treatment
Flint said the findings wont change much when it comes to treating your blood pressure with medications.
It turns out that the medications do both, so we dont have to make things more complicated in terms of picking and choosing medications, Flint said.
Everybody reacts to the medications in different ways. Really, its just a matter of working with your physician to find the right medication, the right dose to achieve both of those numbers. All the classes of anti-hypertensive medications work for both numbers, he said.
While these findings may not make much difference in the medications I give my patients, it is an opportunity to reinforce with the lay public that the lower your blood pressure, the lower your risk of heart attack, heart failure, stroke, and kidney disease, Oskoui said.
We can remind our patients to cut out alcohol, exercise in moderation, and lose weight. Even a 10 to 15 pound weight loss can mean the difference between medication or not, Oskoui added.
That advice echoes what the American Heart Association recommends:
- Eat a well-balanced diet low in salt.
- Limit your alcohol.
- Take your medications as prescribed.
- Work with your doctor.
What Does A Blood Pressure Reading Look Like
When you have your blood pressure measured, you will be given two numbers, a top number and a bottom number.
- Systolic blood pressure. This is the first, or top, number. This is the highest level your blood pressure reaches when your heart beats, forcing blood around your body.
- Diastolic blood pressure. The second number, or bottom number, is the lowest level your blood pressure reaches as your heart relaxes between beats.
Blood pressure is measured in millimetres of mercury . If the first number is 120 and the second number is 80, this would be written as 120/80mmHg, and youd call it 120 over 80.
This video explains more about systolic and diastolic blood pressure.
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Whats The Most Important Blood Pressure Numberis It The Top Or Bottom Number
In the past, it was commonly thought that the diastolic pressure or bottom number was the most important blood pressure number. This mistaken idea dates back to one of the early studies of the treatment of blood pressure, where only patients with diastolic blood pressure over 90 mm were allowed into the study.
More modern studies have shown that the prognosis of hypertensive patients is predicted best by the systolic blood pressure . A systolic pressure of less than 140 when taken at rest in a relaxed state is considered normal.
The next most important number is the pulse pressure, the difference between systolic and diastolic blood pressure. The smaller the number is, the better the prognosis. In other words, a blood pressure of 120/90 is actually better than a blood pressure of 120/50. The reason is this: When the heart pumps its blood into the aorta, the big artery of the body, it is supposed to absorb the energy as it expands to accept the delivered blood. The more youthful and elastic the aorta is, the more energy it absorbs and the more it smoothes out the systolic and diastolic pressures. An older, diseased, and calcified aorta has very little elasticity and so the pressure goes up very fast when the heart pumps its blood into the aorta, and then the pressure drops rapidly between beats, resulting in a large pulse pressure. So a large pulse pressure is a sign of a stiff and inelastic aorta.
Ways To Lower Your Blood Pressure Number
Medication Used To Lower Blood Pressure:
- Water pills or diuretics: They help your kidneys flush water and sodium from your body.
- Beta-blockers: They make your heart beats slower and less forcefully.
- Angiotensin-converting enzyme inhibitors
- Angiotensin II receptor blockers
- Calcium channel blockers: To relax your blood vessels.
- Renin inhibitors: To keep your kidneys from making a chemical that can lead to higher blood pressure.
Ways To Lower Blood Pressure Naturally:
- Pressure Points: These points, such as the 3rd eye point, can help you relax which can help lower your blood pressure
- Breathing Exercises: One of the most popular is deep breathing. These simples, easy to do exercises can help lower your blood pressure instantly.
- Self-Massage: In just a few minutes you can help lower your blood pressure anywhere with a simple face massage starting between your eyebrows, over your eyebrows around to your temples.
Check out one of my articles in this same website that goes into complete detail how to lower your blood pressure with techniques that can be done anywhere and by yourself by
Lifestyle Changes To Lower Blood Pressure:
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How To Measure Blood Pressure
Blood pressure is measured in millimetres of mercury, mmHg. It consists of two numbers, such as 130/80, which we say as 130 over 80. The first is your systolic blood pressure, the maximum pressure your blood attains as your heart beats and pushes it around your body. The second is your diastolic pressure, the minimum level it reaches between beats.
If You Notice A Sudden Decline In Blood Pressure
A single lower-than-normal reading is not cause for alarm, unless you are experiencing any other symptoms or problems. If you experience any dizziness, lightheadedness, nausea or other symptoms, its a good idea to consult with your healthcare provider. To help with your diagnosis, keep a record of your symptoms and activities at the time they occurred.
Is low blood pressure related to low heart rate? Find out.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
Last Reviewed: Oct 31, 2016
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What Does High Blood Pressure Feel Like
High blood pressure often doesn’t have any symptoms, so you usually don’t feel it.
Hypertension is usually diagnosed by a health care professional during a routine checkup. The average person should get a blood pressure reading at least once a year. As a cardiologist, I think its important for everyone to know their numbers. That means knowing what your blood pressure is. And it also means knowing your blood sugar level, cholesterol and body mass index. When you know your numbers, you can work with your doctor to make a plan to reduce any risks.
Blood pressure is even more important to pay attention to, though, if you have a close relative with hypertension or other risk factors. And know that if your blood pressure is extremely high, you may have unusually severe headaches, chest pain, difficulty breathing or get easily worn out by workouts. If you have any of these symptoms, see your doctor right away.
If You Get A High Blood Pressure Reading
- A single high reading is not an immediate cause for alarm. If you get a reading that is slightly or moderately higher than normal, take your blood pressure a few more times and consult your healthcare professional to verify if there s a health concern or whether there may be any issues with your monitor.
- If your blood pressure readings suddenly exceed 180/120 mm Hg, wait five minutes and test again. If your readings are still unusually high, contact your doctor immediately. You could be experiencing a hypertensive crisis.
- If your blood pressure is higher than 180/120 mm Hg and you are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, difficulty speaking, do not wait to see if your pressure comes down on its own. Call 911.
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How Common Is Hypertension In Children
Hypertension is becoming increasingly common in children and adolescents. A recent study that looked at 15,000 adolescents found that nearly one in five had hypertension. And theres reason to believe that hypertension is vastly underdiagnosed in children, since:
- it can be difficult to measure in infants and young children
- its sometimes challenging to identify
- its often thought of as not something that really affects kids
The rise in the number of children with primary hypertension in the United States is thought to correlate with the rise of obesity.
Signs And Symptoms Of Hypertension
Often, kids and teens with pre-hypertension or stage 1 hypertension wont show any symptoms at all. If your child has stage 2 hypertension, she might experience one or more of the following symptoms:
- abdominal pain
- breathing problems
An infant with stage 2 hypertension may seem irritable, not be feeding properly, or vomiting. Sometimes these infants are diagnosed with failure to thrive.
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How Is High Blood Pressure Diagnosed
High blood pressure usually has no symptoms. So the only way to find out if you have it is to get regular blood pressure checks from your health care provider. Your provider will use a gauge, a stethoscope or electronic sensor, and a blood pressure cuff. He or she will take two or more readings at separate appointments before making a diagnosis.
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For children and teens, the health care provider compares the blood pressure reading to what is normal for other kids who are the same age, height, and sex.
Get Regular Blood Pressure Checks
If your blood pressure is in the healthy range and you have no other risk factors for cardiovascular disease, and no personal or family history of high blood pressure, it is still important to have a check at least every two years. Your doctor can also check your blood pressure during routine visits.
If your blood pressure is highnormal , or if you have other risk factors for cardiovascular disease, such as a personal or family history of high blood pressure, stroke or heart attack, it is best to have it checked more frequently such as every 6 to 12 months or as directed by your doctor. Ask your doctor for advice.
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Frequently Asked Questions About Hypertension
Q: If left untreated, does hypertension get worse?
A: Its hard to say. Researchers are starting to see that kids and adolescents with pre-hypertension are more likely to develop stage 1 hypertension, but we dont know if or when stage 1 hypertension will progress to stage 2.
Q: Can hypertension be cured?
A: In some cases, secondary hypertension can be fixed. For example, if:
- its caused by a narrowing in a blood vessel that the doctors are able to widen
- its caused by a rare endocrine tumor that doctors are able to treat successfully
There are also cases in which hypertension might be transient for example, if its caused by a temporary inflammation of the filters in the kidney.
Even when hypertension cant be fixed, it can almost always be well-controlled, with diet and exercise and/or medication.
Q: If my child is being treated for hypertension, what should I watch out for?
A: Keep an eye out for:
- chest pains
- severe headaches that dont seem to respond to at-home treatment
- changes in vision
- swelling of hands and feet
- shortness of breath with limited exertion
- changes in her urine
Q: Will my child need to go on medication?
A: Only a fraction of kids with hypertension require medication. Frequently, its treated with diet and exercise modification first. And if the child is overweight, every kilogram of weight she loses, her blood pressure could bring her blood pressure down by about a point.
Q: Will my child have hypertension as an adult?
How Do Doctors Diagnose High Blood Pressure
Because symptoms are so uncommon, the only way to know you have HBP is to have your blood pressure tested at your doctors office. Your doctor will use a device called a sphygmomanometer, which features an inflatable cuff that wraps around your upper arm. The cuff is attached to a scale, and when it inflates, it measures your systolic BP. It measures your diastolic BP as the cuff slowly deflates. Your doctor will also likely press a stethoscope to listen for any abnormal sounds as your blood flows.
You officially have HBPyour doctor may call it hypertensionwhen your readings are above normal during at least two visits to the doctor. However, many doctors will ask you to measure your own blood pressure using either a home monitor or with a 24-hour monitoring device your doctor lends you. Doing this will help confirm that your blood pressure remains high during the normal course of your day.
Why is this important? Many people have whats called white-coat hypertension, which means that your blood pressure spikes in your doctors office but returns to normal elsewhere. For example, your reading may be high when you have a physical and normal when you use the device at your pharmacist or grocery store .
Lets look at the numbers. The American Heart Association provides the measurements that you should aim for, as well as the ranges that put you in the danger zone. All measurements are mm Hg.
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