Why is Blood Pressure Important?
Do you ever wonder why your physician keeps checking your blood pressure at your annual checkup? What is a normal blood pressure reading?
Blood pressure is the pressure of blood pushing against the walls of your arteries as they carry blood away from your heart. Chronically elevated blood pressure, or hypertension, puts a strain on the arteries and the heart and is a risk factor for cardiovascular diseases such as heart attack and stroke. The American College of Cardiology/American Heart Association (ACC/AHA) define normal and abnormal blood pressure as follows (1):
| Blood Pressure Category | Systolic Blood Pressure | Diastolic Blood Pressure |
| Normal | <120 mmHg | <80 mmHg |
| Elevated | 120-129 mmHg | <80 mmHg |
| Hypertension | ||
| Stage 1 | 130-139 mmHg | 80-89 mmHg |
| Stage 2 | ≥140 mmHg | ≥90 mmHg |
Nearly half of adults in the United States (47%) have hypertension or are taking medication for hypertension (2). Most people with high blood pressure have no symptoms and it is only through a screening blood pressure check that they discover the issue. The US Preventive Services Task Force recommends screening for hypertension every year in adults 40 years or older and in adults with increased risk. For adults 18-29 years who are not at increased risk for hypertension, screening less frequently (every 3-5 years) is appropriate (3). Some risk factors for hypertension include family history, increasing age, black race, obesity, or lifestyle factors such as a high sodium diet, physical inactivity, too much alcohol, or tobacco use.
You can get your blood pressure checked several ways such as by a health care team member at a doctor’s office, at a pharmacy, or with a home blood pressure monitor you can use yourself.
To get an accurate reading, sit in a comfortable chair with your back supported for at least 10 minutes before the reading. Put both feet flat on the ground and rest your arm with the cuff on a table at chest height (heart level). The blood pressure cuff should be against your skin and not over clothing and avoid talking during the measurement (4).
If your blood pressure is high, it is handy to write down various readings at different times of day and keep a log so you talk to your health care team about next steps for treatment. Often you can start with some lifestyle adjustments (such as a low salt diet or increased exercise), but there are several medications that can improve your blood pressure if needed. With normal blood pressure, your chances of living longer and healthier are that much better!
Monitoring Blood Pressure at Home
Some people will have elevated blood pressure readings while at the doctor or dental office and wonder if those readings are true or a result of the stress related to those situations. “White coat hypertension” is a condition where patients have elevated blood pressure readings in the clinic, but normal readings at home. Your doctor may ask you to do self-measured blood pressure monitoring (SMBP). This means using a personal blood pressure device to track your blood pressure readings in a more relaxed setting.
Others with diagnosed hypertension may notice their readings are lower at home compared to the doctor’s office. Self-measured blood pressure monitoring can be a way to show their physician adequate blood pressure control to avoid increasing medication burden. Evidence shows that people with high blood pressure are more likely to lower their blood pressure if they use SMBP combined with support from their health care team than if they do not use SMBP (1).
There are many different blood pressure devices on the market and here are some helpful tips when shopping for a monitor. Ask a medical professional for assistance in selecting the proper cuff size. Make sure the device you are purchasing has been clinically validated to be accurate (see websites in references 2 and 3). Wrist cuffs may be accurate but are very sensitive to body position and may read higher due to the narrower arteries at the wrist (4). As such, arm cuffs are generally easier to use.
The correct way to measure your blood pressure includes sitting comfortably in a chair with back support for at least 10 minutes before your reading. Put both feet flat on the ground and rest your arm with the cuff on a table at heart level. The blood pressure cuff should be snug but not tight and against your skin and not over clothing. Avoid talking during the measurement. Take at least two readings, 1 or 2 minutes apart, in the morning and at night, and log these measurements for a 7 day period (5). Share your readings with your physician who will look at both the range of blood pressures and the average of the measurements.
Being mindful of these readings can help you communicate with your physician regarding your blood pressure and keep you on track to preventing heart disease and stroke.
References
- Shimbo D, et al. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement from the American Heart Association and American Medical Association. 22 Jun 2020. Volume 142, Issue 4:e42-e63
- Hypertension Canada. Blood Pressure Devices. Available at hypertension.ca. Accessed October 4, 2021.
- American Medical Association. US Blood Pressure Validated Device Listing. Available at validatebp.org. Accessed October 4, 2021.
- Sheps, SG. How accurate are wrist blood pressure monitors? Feb 21, 2021. Available at mayoclinic.org. Accessed on October 4, 2021
- National Association of Community Health Centers. Self-Measured Blood Pressure Monitoring (SMBP) Implementation Toolkit. December 2020
- Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison C, et al. Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. 2018;71(19):e13–115.
- Centers for Disease Control and Prevention. Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among U.S. Adults Aged 18 Years and Older Applying the Criteria from the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2015–2018. Atlanta, GA: U.S. Department of Health and Human Services; 2021. Accessed March 12, 2021.
- USPSTF. Hypertension in Adults: Screening. April 27, 2021. Available at uspreventiveservicestaskforce.org. Accessed October 4, 2021.
- Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Measure Your Blood Pressure. Reviewed September 27, 2021. Available at cdc.gov. Accessed October 4, 2021
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– Rachel R. Dirksen, MD
Remedy Internal Medicine
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