Understanding Blood Pressure Numbers: What’s Healthy, What’s Not
Knowing your blood pressure levels is essential for a healthy heart.
“It’s so, so, so important to know your [blood pressure] numbers,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center.
First reason: High blood pressure is one of the major risk factors for cardiovascular disease. Second: High blood pressure is often called the “silent killer,” because the majority of the time patients with high blood pressure don’t feel any symptoms, says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital.
In many cases, by the time high blood pressure is detected, a lot of the damage—which can sometimes be life-threatening—has already been done. “The only way for you to truly know if you have elevated blood pressure is to go to your doctor and get a wellness visit,” says Dr. Bond.
If you’ve been diagnosed with high blood pressure, your doctor may recommend that you get your blood pressure levels checked regularly, whether that’s checking your blood pressure numbers at home yourself, or seeing your doctor more frequently.
If you’re over 40 years old or are high risk for blood pressure, it’s recommended that you get your blood pressure checked once a year. If you’re between 18 and 40, get your blood pressure checked every three to five years, or per your doctor’s advice.
What Blood Pressure Numbers Mean
“When we’re thinking about blood pressure, we’re talking about two different numbers: the systolic, which is the top number, and the diastolic, which is the bottom number,” says Paul Knoepflmacher, MD, a clinical instructor in medicine at The Mount Sinai Hospital.
- Systolic blood pressure measures the pressure in your blood vessels when your heart beats.
- Diastolic blood pressure measures the pressure in your blood vessels when your heart rests in between beats.
So if your measurement reads 120 systolic and 80 diastolic, your doctor would say “120 over 80,” or you’d see it written as “120/80 mmHg.”
Your blood pressure reading will fall into one of four categories, according to Dr. Knoepflmacher.
- Normal blood pressure is less than 120 (systolic) over less than 80 (diastolic).
- Elevated blood pressure is between 120 and 129 (systolic) over less than 80 (diastolic).
- Hypertension stage 1 is between 130 and 139 (systolic) over 80 to 89 (diastolic).
- Hypertension stage 2 is 140 or greater (systolic) over 90 or greater (diastolic).
How to Treat High Blood Pressure
In early stages of treatment for high blood pressure, medication may not be necessary. “If the blood pressure is either borderline or it’s on the low end of hypertension, usually we can get away with lifestyle modifications,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. “If we need to use a medication, can generally get away with taking one medication.”
Ways to lower blood pressure naturally include maintaining a heart-healthy diet (your doctor may recommend the DASH diet, which is specifically geared to lower high blood pressure), getting enough physical activity, losing weight if you need to, and keeping your stress levels low.
“Once we start to get to the higher [blood pressure] numbers, it’s harder to expect that just changing their lifestyle or taking one medication is going to lower the blood pressure,” says Dr. Bloom. “Those are the situations where we start to have to use more than one medication, sometimes two or three or even four medications, to get the blood pressure under control.”
Now that you’ve brushed up on your blood pressure smarts, test your knowledge with this blood pressure quiz.
Dr. Bond is a cardiologist and associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and an assistant professor of cardiology at Hofstra Northwell School of Medicine.
Paul KnoepflmacherDr. Knoepflmacher is a clinical instructor of medicine at The Mount Sinai Hospital in New York City, where he also maintains a private practice.
Michelle Weisfelner BloomDr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.
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The majority of the time, patients don't actually feel
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any symptoms with high blood pressure.
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That's why it's called the silent killer.
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Really, the only way for you to truly know
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if you have elevated blood pressure
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is to go to your doctor and get a wellness visit.
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(upbeat music)
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When we're thinking about blood pressure,
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we're talking about two different numbers,
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the systolic, which is the top number,
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and the diastolic, which is the bottom number.
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Both are important.
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When we're talking about normal blood pressure,
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we're talking about less than 120 over less than 80.
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When we're discussing elevated blood pressure,
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we're talking about a systolic blood pressure
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of 120 to 129 on the top and less than 80 on the bottom.
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Within hypertension, there's what we call stage one,
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which would be 130 to 139 on the top,
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or 80 to 89 on the bottom.
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If you have stage two hypertension,
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that's considered a systolic of 140 or greater,
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or a diastolic of 90 or greater.
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If patient is in the early stages of high blood pressure,
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for example, if the blood pressure is either borderline
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or it's on the low end of hypertension,
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usually we can either get away with lifestyle modifications,
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meaning if a patient loses weight,
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a patient follows a very careful diet, low in sodium
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and high in fruits and vegetables, and things like that,
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or a patient, if we need to use a medication,
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can generally get away with taking one medication.
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Once we start to get to the higher numbers,
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it's harder to expect that just changing their lifestyle
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or taking one medication is going to lower
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the blood pressure enough to make a meaningful difference.
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And those are the situations where we start
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to have to use more than one medication,
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sometimes two or three, or even four medications,
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to get the blood pressure under control.
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The conversations that we have around blood pressure
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depend on really the risks that the person has
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for cardiovascular disease, because as we know,
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high blood pressure is one of the major risk factors
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for cardiovascular disease.
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But we address patients' blood pressure differently
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based on their risk status.
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For instance, a diabetic who is at high risk
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for heart disease, we treat them
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actually as if they have heart disease
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and we would like to aim for a blood pressure
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that's lower than a person who doesn't have that risk.
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So, so, so important to know your numbers.
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You're not always at a doctor's office,
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so your doctor wants to know that when you're not there,
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you're still having controlled blood pressure.
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If your doctor recommends that it's important
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to get a blood pressure monitor at home
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so that you know your numbers all of the time,
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and if there's anything you're concerned about,
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please call your doctor to let them know,
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because it's more important to treat your blood pressure
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than to let it go until the next visit.
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Measuring High Blood Pressure. Atlanta, GA. Centers for Disease Control and Prevention. (Accessed on January 31, 2021 at https://www.cdc.gov/bloodpressure/measure.htm)
Get Your Blood Pressure Checked. Bethesda, MD. U.S. Department of Health and Human Services, HealthFinder.gov. (Accessed on January 31, 2021 at https://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-blood-pressure-checked)