What is considered normal vs. high blood pressure?

How do age and other risk factors affect these guidelines?

According to the AHA, if you have no history of CVD (cardiovascular disease), or have an estimated 10-year risk of developing atherosclerotic cardiovascular disease (ASCVD) greater than 10%, the blood pressure threshold for initiating antihypertensive medication therapy is as follows:  

1. Under 60 years old: 140/90 mmHg or higher
2. Over 60 years old: 130/80 mmHg  or higher

HOWEVER, guidelines are just that, and each case is unique.  Every patient is unique, which means that their individual circumstances must be taken into account and a careful risk/benefit analysis undertaken before recommending a treatment.

What causes high blood pressure?

A number of things can cause high blood pressure, but there are two different types primary hypertension and secondary hypertension.

Primary (essential) hypertension: This is the most common type of high blood pressure. It usually develops over a long period of time, and is not caused by an underlying illness, but rather by lifestyle factors, aging, and/or demographics, e.g. males and non-Hispanic African-Americans are more likely to develop high BP. Risk factors include, but are not limited to:

• Excess alcohol consumption
• Smoking
• Excess salt consumption
• Obesity
• Sedentary lifestyle
• Poor diet
• Not enough potassium in diet
• Not enough calcium in diet

Secondary hypertension: This type of high blood pressure is less common, and is caused by an underlying condition or disease process, such as:

• Obstructive sleep apnea
• Pregnancy
• Kidney disease
• Diabetes
• Endocrine disorders, including:
• Cushing’s syndrome
• Aldosteronism
• Thyroid and parathyroid disorders
• Pheochromocytoma

You might be surprised to learn that Secondary Hypertension can be caused by many common medications, including some everyday NSAID pain relievers like ibuprofen (Motrin or Advil) and naproxen (Aleve). However, acetaminophen (Tylenol) is unlikely to cause this. Other medications that may raise your blood pressure include:

• Decongestants: e.g. pseudoephedrine (Sudafed); phenylephrine (Sudafed PE, Neo-Synephrine); oxymetazoline (common in nasal sprays, e.g. Afrin)
• Stimulants, e.g. caffeine, methylphenidate (Ritalin), bupropion (Wellbutrin), amphetamines, cocaine.
• Antidepressants, including SSRIs, e.g. fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil); tricyclics, e.g. protriptyline (Vivactil), nortriptyline (Pamelor); SNRIs, e.g. venlafaxine (Effexor), duloxetine (Cymbalta).
• Certain biologics, e.g. angiogenesis inhibitors
• Corticosteroids, e.g. prednisone, dexamethasone, methylprednisolone (Medrol)
• Oral contraceptives
• Certain herbal supplements, e.g. ma huang or bitter orange (check with your physician)

How to Control High Blood Pressure!

Q & A with Dr. B

Why should a cardiologist manage my BP and not my primary care physician (PCP) or family medicine practitioner (FP)?

High blood pressure primarily impacts your cardiovascular system, although other organs may ultimately be damaged. Beyond stating the obvious point—which is that cardiologists are uniquely qualified as specialists in preventing, diagnosing, and treating CVD—PCPs and FPs have been slow to adopt the recommendations of the AHA or the American College of Cardiologists (ACC) with regard to primary prevention measures for CVD, or have even disagreed with them. For example, the American Association of Family Physicians (AAFP) defines hypertension as 140/90 mmHg, whereas AHA/ACC’s definition is 130/80. Similarly, AAFP does not see the value in using coronary artery calcium (CAC) scores for screening, while cardiologists view it as an important tool to objectively assess the extent of coronary artery blockage, and thus, risk of future heart attack. (Click here to see a chart of key differences between AAFP and AHA regarding prevention.)

Why do you prefer 4 blood pressure readings to be submitted in the B100 home test, isn’t one or two readings enough?

Blood pressure varies depending on time of day, hydration, activity level, mood (anxiety/stress), body position (sitting/standing/lying down), position of blood pressure cuff, and medications you may be taking. You should make sure to follow our instructions to negate the influence of these as much as possible; however, there will still be significant variance. Therefore, obtaining four readings is recommended. In this way, we can see an average of your blood pressure based on more data points, which should be a more accurate representation.

High blood pressure runs in my family. Can I still prevent it?

You cannot prevent your genetic predisposition toward high blood pressure. However, what you can do, by making smart and informed lifestyle choices, is to lessen the impact of that genetic predisposition to the best of your ability. These lifestyle choices primarily involve: (1) keeping your weight within normal limits; (2) glycemic control (not letting your glucose or HbA1C exceed normal limits), which is accomplished by eating fewer carbs; (3) not eating too much sodium; (4) controlling dyslipidemia (high LDL and/or low HDL levels), which is accomplished by eating fewer carbs, cutting out trans fats, and eating more monounsaturated fats like olive oil (the Mediterranean diet is great for this); and (5) doing regular, moderate-intensity exercise (not being sedentary). Of course, items (2) through (5) help you do (1)!

I don’t have a blood pressure machine. Are there signs or symptoms I can look for that my BP is high?

Every household in America should have a blood pressure machine.  This is why include one in the B100 home test.  Often, there are no signs or symptoms of high blood pressure. This is why doctors often refer to it as “the silent killer,” and why regularly checking your blood pressure is so important. If you are experiencing symptoms such as severe headache, shortness of breath, and nosebleeds, these can occur in the setting of a hypertensive crisis (BP 180/120 mmHg or more). However, such symptoms are not specific, and you certainly should not wait for the development of such symptoms before concluding that you have high blood pressure. Otherwise, you may risk severe organ damage, heart attack, or death.

I know I have high blood pressure and take my medication, my doctor checks it for me. Why should I still check it at home?

There are several reasons:

(1) The BP measurement your doctor takes may actually not be the most accurate due to “white coat hypertension.” This refers to the effect of your BP going up simply as a result of the anxiety of being at the doctor’s office. Therefore, the readings your doctor takes may be artificially high, and home readings may be more reflective of your true BP.

(2) The more BP measurements you take, the more you can negate the influence of variation due to error and get a more accurate idea based on an average.

(3) By continuing to take regular BP measurements in between visits, your doctor can see a trend of your BP and assess how well (or not) your BP medication is working.

I was diagnosed with high blood pressure, but I have been maintaining lower readings, so I can stop taking my medication, right?

Wrong! First of all, never stop taking any prescribed medication without your doctor’s approval. Second, it is likely that is only because of the medication you’ve been taking that you have been able to maintain those lower readings. And if you stop taking your medication, your BP will, in all likelihood, shoot right back up. Why ruin your progress? If you have problems with your medication because of side effects, talk to your doctor; never just stop taking it.

My blood pressure fluctuates, some days its high but a majority of the time it is good. This is harmless right?

Some fluctuation in blood pressure is normal, but it is impossible to conclude it is “harmless” without seeing exactly how much it fluctuates. If it is extreme, then it is not harmless. Talk to your doctor; he or she may wish to order a 24-hour blood-pressure monitor to assess further.

Will cutting salt cure my high blood pressure?

Not necessarily. Sodium is just one factor in high blood pressure, and it may or may not apply in your individual case. If you are “salt-sensitive,” cutting sodium intake seems to help reduce BP. However, as we have mentioned before, in addition to reducing sodium intake, you should make sure to follow our other healthy lifestyle recommendations in order to help lower your BP. Finally, when you cut sodium, make sure you are getting enough potassium!

I am under 40, I don’t need to check my blood pressure, right?

Wrong! You can have high BP at any age, and you should check your BP to ensure it is within normal limits.