Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps. Maintaining healthy blood pressure is important because sustained high pressure can damage blood vessels and organs throughout the body.
Interpreting Blood Pressure Readings
A blood pressure reading consists of two numbers: systolic and diastolic. The systolic number represents the pressure in your arteries when your heart beats and pumps blood. The diastolic number indicates the pressure in your arteries when your heart rests between beats.
Medical guidelines categorize blood pressure into several stages. Normal blood pressure is defined as less than 120 mmHg systolic and less than 80 mmHg diastolic. Elevated blood pressure occurs when systolic readings are between 120-129 mmHg and diastolic readings are less than 80 mmHg.
Stage 1 hypertension is diagnosed when systolic pressure is between 130-139 mmHg or diastolic pressure is between 80-89 mmHg. Stage 2 hypertension is characterized by systolic readings of 140 mmHg or higher, or diastolic readings of 90 mmHg or higher. A hypertensive crisis, a medical emergency, occurs when systolic pressure exceeds 180 mmHg and/or diastolic pressure exceeds 120 mmHg.
Determining When Medication is Needed
The decision to start blood pressure medication depends on your blood pressure readings and overall cardiovascular risk. For individuals with Stage 2 hypertension (systolic at least 140 mmHg or diastolic at least 90 mmHg), medication is recommended alongside lifestyle changes to reduce complications.
For those with Stage 1 hypertension (systolic 130-139 mmHg or diastolic 80-89 mmHg), medication may be considered if there is a high risk of atherosclerotic cardiovascular disease (ASCVD), such as a 10-year risk of 10% or more. In such cases, medication is started with lifestyle modifications. If the 10-year ASCVD risk is less than 10%, lifestyle changes are tried for three to six months before medication is considered.
In situations where blood pressure is significantly elevated, such as 160/100 mmHg or higher, prompt evaluation and initiation of drug treatment are recommended. The decision to prescribe medication is individualized, made in consultation with a healthcare provider, and considers a person’s health profile and risk factors. The goal is to achieve a blood pressure target of less than 130/80 mmHg for most adults.
Considering Other Health Factors
Blood pressure numbers alone do not always determine the need for medication. Other health conditions influence the decision to prescribe medication. For example, individuals with diabetes, chronic kidney disease, or established cardiovascular disease require earlier medication, even at lower blood pressure readings.
If a person has a history of stroke or heart attack, medication may be started even if blood pressure is not at general thresholds. Age also plays a role, with guidelines for older adults recommending medication for systolic blood pressure at or above 130 mmHg. A comprehensive assessment of overall cardiovascular risk, including factors beyond blood pressure, guides individualized treatment plans.
The Importance of Lifestyle Changes
Lifestyle modifications are a foundational component of blood pressure management, whether medication is prescribed or not. These changes are often the initial approach for elevated blood pressure and are consistently recommended to enhance the effectiveness of medication and promote overall health. Adopting a balanced diet, such as the Dietary Approaches to Stop Hypertension (DASH) eating plan, can contribute to significant reductions in blood pressure.
Regular physical activity, aiming for consistent exercise, helps lower blood pressure and improve cardiovascular health. Reducing sodium intake in the diet is another effective strategy, as excessive sodium can raise blood pressure. Maintaining a healthy weight, managing stress through various techniques, and moderating alcohol consumption are also important lifestyle adjustments that support blood pressure control.