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Think Your Blood Pressure's Healthy? Think Again

If you have high blood pressure, you know you need to take steps to lower it—but how much? Maybe more than you think. Several studies published late in 2015—notably, one known as SPRINT involving more than 9,000 people—found that millions of Americans could benefit from a lower target than typically recommended. What's more, a 2017 study published in the American Journal of Epidemiology estimates that nearly 1 in 8 Americans—or approximately 17.1 million—have masked hypertension. That's blood pressure that looks normal in the doctor's office but is actually too high. 

Blood pressure primer

Backing up, what exactly is blood pressure? It’s the measurement of how hard your blood is pressing into your veins and arteries. The top number (systolic) measures the pressure during your heartbeats. The number on the bottom (diastolic) measures it between beats. Doctors define hypertension as a reading above 140/90. “Normal” blood pressure is less than 120/80. Readings in the middle are called “prehypertension.”

Current guidelines suggest aiming for a systolic pressure of 140, or even 150 for seniors. But research suggests a target of 120 could save many more lives.

The benefit of going low

In the SPRINT study, participants were over 50 and already had either heart disease or chronic kidney disease, or they were older than age 75—all factors that make them high-risk for a heart attack or stroke. Among that group, dropping their systolic pressure to near 120 reduced their risk of dying from any cause by 27%, and from heart-related conditions by 43%.

But getting your systolic blood pressure down to 120 isn’t for everyone. It often means taking two or three medications. Lifestyle changes like losing weight or reducing salt help, but only so much. “When patients have really high blood pressure, you’re going to need medication to get it down,” says Michael Arcarese, MD of Chippenham Hospital and Cardiac Associates of Richmond in Virginia. “If somebody’s at 135 and they drop some weight, maybe they’ll get down to 130. But most patients will need medication.”

And those drugs carry a small chance of serious side effects, such as low blood pressure and kidney problems. “There’s somewhat of a price to pay, but when you’re talking about a reduction in deaths and cardiac events, that’s what people care about,” says Arcarese. Current targets are higher, in part, to avoid those concerns. “Some of that came out because we were overtreating patients, and they were feeling dizzy or falling because their blood pressure was too low,” Arcarese says.

So what to do?

If you have high blood pressure, talk to your doctor about how—and how far—to lower it. Some are already on board with the lower goals, but others may be taking a wait-and-see approach. “You have a new study that says one thing, in contradiction to the guidelines,” says Dr. Acarese. “You don’t want to go against the guidelines.” But the SPRINT study makes such a good argument that Arcarese expects them to change. “That hasn’t come yet, but if it does you’ll see a rapid change.”

This article was updated on January 26, 2017

See More from Dr. Arcarese:
How much do I need to walk to lower my blood pressure?
How does plaque in the arteries affect blood pressure?
Is angina related to blood pressure?

Hypertension

Hypertension

Clinically known as hypertension, high blood pressure can cause a host of problems if left untreated. The most common type of cardiovascular disease, high blood pressure causes our hearts to work harder by forcing blood to push ag...

ainst the walls of our arteries at an elevated level. Hypertension is the leading cause of strokes and heart attack. It also increases your risk of having heart and kidney failure and hardening of the arteries, a condition called atherosclerosis.
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