Why Your Blood Pressure Probably Isn't Normal & What You Need To Do About It.
We do a terrible job of identifying and managing high blood pressure.
We do a terrible job of identifying and managing high blood pressure.
We can send spacecraft across the solar system.
We have managed to harness the power of the atom.
And we still do an awful job of identifying and managing high blood pressure.
Here’s why.
And what to do about it.
The Scale Of The Problem.
As a risk factor for death, high blood pressure is responsible for more deaths than any other risk factor, including smoking.
Just let that sink in for a second.
No matter where you look.
Globally. Developed nations. Developing nations.
It doesn’t matter.
High blood pressure is the risk factor associated with the most early deaths compared to any other risk factor.
And we do a terrible job of even identifying IF someone has high blood pressure.
How terrible, I hear you ask.
When it comes to high blood pressure, there is the rule of ‘Halves’1.
About Half of all adults have high blood pressure2.
About Half of those with high blood pressure are undiagnosed.
About Half of those who are diagnosed are not treated.
And about Half of those who are treated are not treated properly.
That, my friends. Is awful.
What Is Normal Blood Pressure?
Let’s make this simple.
A normal blood pressure is 120/80 mmHg or below.
Yes. Of course, there will be exceptions to this figure.
But odds are, your blood pressure should be in this range.
And if it’s not, your risk of:
Heart disease.
Heart attack.
Stroke.
Kidney disease.
Dementia
An early death.
Go up. A lot.
For every 20 mmHg increase in systolic blood pressure above normal, the risk of dying from a heart attack or stroke doubles3.
What is high blood pressure?
The standard answer here is any blood pressure above 140/90 mmHg.
Some countries suggest a figure of anything above 130/80 mmHg.
But the simple answer is:
Anything above what we consider normal. I.e. 120/80 mmHg.
The rest is a matter of degree.
If your blood pressure is routinely 128/80 mmHg, your risk is increased. By a small amount.
But if your blood pressure is routinely 150/95 mmHg, your risk increases MUCH more.
Try to think of high blood pressure like speed.
Five miles per hour over the speed limit is still speeding. But the risk it carries is likely to be modest.
Fifty miles per hour over the speed limit is also speeding.
The risk, however, is substantially more.
Nothing magic happens at an exact blood pressure number.
It is all a matter of degree.
Measuring Blood Pressure.
What isn’t measured isn’t managed.
If you don't measure your blood pressure, you don’t know if it is an issue.
But let’s start by stating something most people do not understand.
In my experience, blood pressure measured in a doctor's office is as close to useless as it makes no difference.
Yes. You read that correctly.
Useless.
We do it for purely theatrical reasons.
As a patient, a doctor’s visit usually involves:
Bad traffic, bad parking, bad coffee and apprehension.
Not exactly an ideal setup for measuring blood pressure.
Why on Earth did we ever think we could get a proper picture of our blood pressure in a doctor's office?
Sure. You could relax for 15 mins in a quiet room.
Have an automated blood pressure done with no interruptions.
And then you might get a better picture.
But is that what happens at your doctor’s office?
I didn’t think so.
I ask ALL of my patients to measure their blood pressure at home.
Over a 10-day period.
First thing in the morning.
After going to the bathroom.
Seated.
Back supported.
Legs uncrossed.
Feet flat on the floor.
Take three measurements with an upper arm cuff (Not a wrist cuff).
Ignore the first reading.
Input the 2nd and 3rd into an Excel file that then averages these figures over the ten days.
That is your blood pressure.
That is HOW you measure your blood pressure.
If the figure that we get is not at least in the low 120s systolic (Top number), I am concerned.
What Should Your Blood Pressure Be?
Answer: Normal.
What is normal?
120/80 mmHg.
It’s not that complicated.
If your blood pressure is high, how can you lower it?
Ideally, with lifestyle approaches. I have covered these in depth in a previous article, which you can read here.
Many patients with high blood pressure do not get to their target blood pressure with lifestyle measures alone and often require medications in combination with their lifestyle approaches.
I am one of the biggest fans of lifestyle approaches to managing high blood pressure.
However, I am also very quick to use blood pressure-lowering medications to get a patient to target.
If they continue to lower their blood pressure with lifestyle approaches and we need to reduce or stop their blood pressure medications, that’s great.
But as an initial approach.
I do whatever is needed to get to target.
What Is The Benefit Of Lowering Blood Pressure To Target?
Multiple trials have shown reductions in major heart events with blood pressure-lowering medications.
Usually, these trials lowered blood pressure to a systolic blood pressure target of less than 140 mmHg.
The question is whether lowering even further to 120 mmHg would be beneficial.
The answer is a clear yes.
I have covered the trials showing this benefit in a previous article, which you can read here.
But here is the main takeaway.
Compared to targeting a systolic blood pressure in the mid-130s, a blood pressure in the low 120s range resulted in about a 25% reduction in major heart events, including heart attacks, stroke, heart failure, etc4.
But get this.
If you started lowering blood pressure to this lower target in your 50s, it is estimated that it would add about three years to your life5.
Think about that.
By being a little more careful with blood pressure control, you could add three additional years to your life.
No magic. No potions. Nothing crazy.
Just good blood pressure control.
So, what should you take away from this article?
Do you even know your blood pressure? (Really Know). A once-off reading in a doctor’s office does not count.
Is it normal?
What do you need to do to get it to target?
All of these questions can be easily answered.
The question is, will you answer them?
Because the odds say that your blood pressure is elevated, and it might just be killing you.
Which is a disaster.
Because of all the problems we face.
This is one we can fix.
When You Are Ready, Here Is How I Can Help.
If you would like to get a concise overview of heart disease and how to prevent it, you can check out my best-selling book, Heart. An Owner’s Guide. You can buy it where all books are sold or by clicking here or on the image below.
Heart Health Evaluation.
If you are based in Ireland and would like to have a comprehensive heart health evaluation at our clinic in the Blackrock Clinic, Dublin, you can learn more by clicking here or on the button below.
https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=An%20estimated%2046%25%20of%20adults,hypertension%20are%20diagnosed%20and%20treated.
https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/?CDC_AAref_Val=https://www.cdc.gov/bloodpressure/facts.htm#
Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002 Dec 14;360(9349):1903-13
A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26;373(22):2103-16.
Assessment of Long-term Benefit of Intensive Blood Pressure Control on Residual Life Span: Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). JAMA Cardiol. 2020;5(5):576–581.
Hi Dr. Barrett, great article, love the very practical guidance.
What do you think about the impact of inadequate sunlight, as Americans spend >90% of their time indoors. My understanding is the NO response in the skin to sunlight is blood pressure lowering.
As always, a great read. An ideal blood pressure goal is quite important and depending on how far away someone is from their ideal goal every little thing they can do can add up to make a huge difference. For some, at some point, medications are necessary. These days, there are quite a few safe medications to choose from but of course convincing someone of taking a medication life-long isn't easy. In my practice, I've found stress to be a huge factor in elevated BP, preceded by only family history.