Michael Hunter, MD on Medika Life

Rethinking Blood Pressure

Cardiovascular disease remains a leading cause of death - here is information everyone should know

IS YOUR BLOOD PRESSURE NORMAL? Are you sure? Researchers are moving the bar on what constitutes an “ideal” blood pressure.

Today we explore a study suggesting that as blood pressure rises above 90 mm, we risk damaging our heart’s blood vessels (coronary arteries). Today we look at that recent discovery before turning to more practical issues about blood pressure measurement:

  • How often should you check your blood pressure?
  • What time of day is best?
  • Should you immediately repeat the measurement?
  • What substances should you avoid for 30 minutes before checking you?

First of all, thank you for joining me today and caring about your health.

Blood pressure basics

I recently bought a blood pressure measuring tool. Do you know what the medical term is for the device? Kudos if you know this remarkably long name: Sphygmomanometer.

When I measure my blood pressure, the machine gives me two numbers, systolic and diastolic blood pressure. The former refers to systole, when my heart pumps blood into the main blood vessels, the aorta.

Photo by Mockup Graphics on Unsplash

Diastolic points to diastole, the resting time when blood refills the heart. My heartbeats and the blood pressure rises to the systolic level. In-between beats, it drops to the diastolic level.

I have long thought that I had ideal blood pressure, with a systolic blood pressure of 110 to 118. The American Heart Association agrees with my assessment, offering these observations about blood pressure:

  • Normal: Systolic less than 120 and diastolic less than 80
  • Elevated: Systolic 120 to 129 and diastolic less than 80
  • High blood pressure, stage 1: Systolic 130 to 139 or diastolic 80 to 89
  • High blood pressure, stage 2: Systolic 140 or higher or diastolic over 90
  • High blood pressure crisis (contact a doctor immediately): Systolic 180 or higher or diastolic over 120

A medical professional must confirm a high blood pressure diagnosis. If you have shallow blood pressure, you should connect with a medical professional.

Blood pressure: A new normal?

Am I right in thinking I am perfect for my blood pressure? Now comes a study that calls our historical definitions of blood pressure into question.

The study title gets right to the point: “Intensive Blood Pressure Control Lowers Cardiovascular Risk.”

Let’s get a bit more granular: When systolic blood pressure rose above 90 mm, the risk of coronary artery damage rose with it. The study suggests that we have made significant improvements in modifying heart disease risk factors (such as tobacco cessation), but we have more work to do. Cardiovascular disease remains the leading cause of death in the USA.

For every 10 mm increase in systolic blood pressure, the risk of calcium deposits and cardiovascular events rose accordingly. Compared with people with systolic pressures of 90 to 99 mm, those with pressures of 120 to 129 mm were 4.58 times more likely to have experienced a cardiovascular event.

Photo by André Filipe on Unsplash

We in the USA (and elsewhere) have work to do. As we put on more and more pounds, we increase our risk of two risk factors for heart disease — type 2 diabetes and high blood pressure.

Yes, we have pills for treatment, but they can come with side effects. You probably know what I am going to say: Use lifestyle, including my five pillars of health:

  • Move (walking is my go-to)
  • Get adequate sleep
  • Eat well (and watch your cholesterol and blood sugar levels)
  • Mindfulness
  • Community engagement

It goes without saying to avoid tobacco and to dodge excess alcohol. Now back to blood pressure. As positive encouragement, I offer this: Individuals in traditional non-industrial societies typically maintain systolic blood pressure in the low 90s throughout life.

Measuring your blood pressure

The Mayo Clinic offers guidance on performing accurate blood pressure monitoring at home:

  • Check your blood pressure device’s accuracy. Check it against your healthcare provider’s office model before you start using a monitor. Your provider can also make sure you are using it correctly.
  • Measure your blood pressure twice daily. Check in the morning before eating or taking medications, and check again in the evening. Aim for the same times each day.
  • Don’t measure blood pressure immediately after you awaken. If you exercise in the morning, check before exercising.
  • Avoid caffeine, alcohol, and tobacco use in the 30 minutes before measuring, and go to the toilet first (a full bladder may increase your blood pressure).
  • Sit quietly during monitoring and always use the same arm. Get your arm to the level of your heart when measuring. Put the cuff on bare skin, not over clothing.
  • Repeat the measurement one to three minutes after the first measurement. Write down the results.

Be kind to your heart, brain, and kidneys. Watch your blood pressure. Most of us, myself included, can do better. Thoughts?


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Michael Hunter, MD
Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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