Blood pressure management is a recurring topic for many of our patients, and it is something that requires teamwork to get right.
Since the pandemic, the way most doctors manage blood pressures has changed. Wherever possible, we have dispensed with many routine in-office visits to reduce the risk of sharing and transmitting infectious diseases like COVID. There is quite a bit of variation around how this is done, however, and I would like to emphasize that how my team and I help patients manage blood pressures these days may not be the way your doctor chooses to do things: so do make sure to discuss the details with your doctor.
Still, I hope this video will help you understand more about blood pressure management, and why it’s so important.
There are many possible health implications to having high blood pressure, but first and foremost, we are trying to manage and prevent stroke. As a quick summary, a stroke is a sudden loss of neurological function due to poor blood flow in a part of the brain. Most commonly, this is due to a blockage of flow, but sometimes it is due to a blood vessel bleeding into the brain. Blood pressure management is important because there is lots of evidence to demonstrate that people with uncontrolled high blood pressure are at a much higher risk of stroke. In fact, there is evidence that of all the things that doctors would do at a traditional “annual physical,” checking blood pressure is the only thing that will make a difference.
It is now pretty easy to get accurate readings of blood pressure and heart rate in the comfort of your own home, as blood pressure machines are widely available (at around $50 for a new machine) and are actually pretty good these days, though periodically you should make sure to confirm that the blood pressure readings are accurate by comparing them with a newer machine, or even one at the doctor’s office.
But what do these blood pressure numbers actually mean? Well, your arteries do not always have the same pressure: when the heart is pumping blood out, generally the arteries will have a much higher pressure than when the heart is in a phase of filling by drawing blood from the veins. So, with every heartbeat, the arteries delivering blood to your body will experience high and low pressures. The machine will generally have a cuff that will go around your upper arm and squeeze, cutting off the blood vessels to measure the lowest and highest pressures in your arteries, using a unit of pressure called “millimeters of mercury.”
The machine will also record your heart rate – that is, how many times your heart is beating per minute – and to check your blood pressure properly, you should usually include the heart rate as well, as an elevated heart rate can be associated with high blood pressure.
So, you should end up with three numbers: the higher pressure, the lower pressure, and the heart rate.
“Is that it?” you might ask. Well, not quite.
It turns out that your blood pressure changes throughout the day, depending on what is going on. If you are active, or even if you have been recently active, or if you are stressed, or even if you have a bowel movement, your blood pressure will naturally go up at these times, which can be entirely normal.
Doctors managing your blood pressure are not so interested in these highs, but they are more interested in finding out your lowest blood pressure. This could also be considered your “resting” blood pressure and heart rate. For some people, the pressures never really get down into a normal range, meaning that the blood pressures are running high nearly all the time. This is called hypertension, which increases your risk of stroke, not to mention other problems like heart attack and kidney disease.
Therefore, checking your blood pressures once or twice is not good enough. In my opinion, if you want to get a good sense of your blood pressures and heart rates, you should check at least five to ten times. And it would not make sense to check over a period of, say, an hour. It would make more sense to check at different times of the day, and over two or three days. Once you have done that, you should have a pretty good idea of how high and low your blood pressures actually go. But do try to check most of the time when you are rested and relaxed, as this is how you will find those lower blood pressures in which we are most interested.
At this point, I suggest you share your blood pressures with my office or your family doctor. And this is when we will evaluate the numbers to see if there are any concerns. Generally speaking, we are looking for your resting blood pressures to be below 140 for the higher number and 90 for the lower number. This has been a long-established cut-off for diagnosing hypertension, as it is above these numbers that your stroke risk would increase at a higher rate. But do keep in mind that if you have diabetes or heart disease, or even kidney disease, there may be reasons why your doctor will recommend aiming for a lower blood pressure than that: perhaps even as low as 130/80.
There are also some reasons, primarily once you are over the age of 70, that your doctor may advise you that the target numbers are higher. This is where you start to see quite a bit of variation between different doctors’ offices. In my practice, we generally aim for blood pressures of 150/95 for people in their 70s, and change that again for people in their 80s and older, to permit a blood pressure target as high as 160/100. The evidence for keeping blood pressures under control at these higher ages is much more sparse. As people get older, they tend to have other medical conditions, and to be taking other medications. It is also quite common to become more frail as we age: so the risks of lowering blood pressures as you get older can often outweigh the benefits. To put that another way, as you get older, while stroke is still a concern, many other possible medical conditions might take priority.
Once your doctor has evaluated your blood pressures and decided whether to keep things the same or modify any medications, you might wonder when you should next check your blood pressures. Assuming you are feeling fine, in my opinion, you can take a break from checking blood pressures for a while. Even a month or two. Most of us have lives that are similar in stress and activity level from week to week, so we would not expect your blood pressures and heart rate to change substantially from one week to the next. So, think of this habit of checking your blood pressures and heart rate as a “check-in” to do every six to eight weeks or so, taking a break in-between. This may mean that you don’t need to check your blood pressure for a couple of months if you are feeling alright. But do then remember to check back in with another five to ten readings, and share those again with your doctor if they are keeping a close eye on your blood pressures.
The habit of checking your blood pressure every day is, most of the time, not necessary or helpful.
I also want to talk about what having high blood pressure can feel like, even if you are not having a stroke. Some people with blood pressure higher than the numbers I’ve already outlined will experience symptoms like headaches and/or visual changes. It would be fairly unusual to experience chest discomfort. Still, if you have a headache, visual changes, or chest pain, and your blood pressures are higher than the numbers I have outlined, you should seek medical attention immediately.
If you are having chest pain, no matter what your blood pressure is, please seek help at a local emergency room.
If, on the other hand, you are feeling fine but have high blood pressure, how high is an emergency? Most doctors would say that a blood pressure of 220/120 or higher is a medical emergency and should lead you to seek medical attention at an emergency room immediately. And if you are consistently finding numbers above 140/90, you should review these with your doctor, ideally within the next few days, but definitely within the next couple of weeks.
Now that we’ve discussed how to figure out if your blood pressure is too high, I want to explain what you might do about high blood pressure. You are probably all aware that we have a number of different medication options that will lower your blood pressure. But you should also be aware that several lifestyle factors will help you get that blood pressure down as well, and even if you have been placed on medication, making changes to your lifestyle can improve your blood pressure, sometimes to the point that you can reduce those medications.
Regular exercise, particularly exercise that gets your heart rate up, will help your blood vessels get used to higher pressures while you are active and help them relax even more when you are resting. Getting enough sleep and managing stress levels are critical to helping your blood vessels relax and reduce your risk of stroke. Finally, you may be aware of the impact of a high salt diet on high blood pressure, as salt tends to cause fluid in the body to hang around, which can be a big contributor to high blood pressures. If you eat out a lot in restaurants or eat a lot of pre-made processed food, chances are you are taking in a lot of salt, and you may want to limit those types of foods if you have high blood pressure. But, if you are already eating a diet lower-than-average in salt, you probably won’t gain much by reducing salt further. If you’re not sure if you are eating too much salt or not, please do see a dietitian. Our patients have access to dietitians in our area, and we are always happy to refer you to them.
I hope you now have a better understanding of what high blood pressure is and how to make sure you work with your doctor to address it and reduce your risk of stroke. Helping your doctor manage your blood pressures is one of the most important areas in which you can play a big part in ensuring good health for many years.
