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Straight, No Chaser: 5 Questions on High Blood Pressure You Must Be Able to Answer

By Jeffrey Sterling, MD September 26, 2018

High-Blood-Pressure
High blood pressure (hypertension) is so prevalent and such a consequence of our society (as will be discussed the rest of this week) that you must have an understanding of some basic principles if you care at all about your health.  I’ve organized these questions for you in a logical progression.  Feel free to offer your own questions or comments.
1. How do I know if I have high blood pressure?  By the numbers, consider this table:

Blood Pressure Levels

NormalSystolic: < 120 mmHgDiastolic: < 80 mmHg
At risk (pre-hypertension)Systolic: 120–139 mmHg

Diastolic: 80–89 mmHg

HighSystolic: 140 mmHg or higherDiastolic: 90 mmHg or higher

Therefore, the first thing is to get checked by your physician if you don’t already have a diagnosis of hypertension and are anywhere at or above the pre-hypertension stage.

2. But when should I get go to the emergency room for high blood pressure?  The presence of the types of symptoms I’ve been discussing here and throughout Straight, No Chaser is a prompt to come to the emergency room regardless of the level of the blood pressure.  Also, regardless of the presence or absence of symptoms, I’ll always want to see you if your bottom number (diastolic blood pressure) is at or above 110-115, regardless as to whether or not you appropriately take your medication.
3. If I do have high blood pressure, will I be placed on medication?  I really hope not, but honestly, approximately two-thirds of individuals in the U.S. who have high blood pressure are poorly controlled – even on medication.  This means medication will be necessary for most.  That said, theoretically, medication should be viewed as necessary only when necessary and only when other measures don’t work.  You should discuss this with your individual physician, and make every effort to improve your diet and exercise regimens.  If and when you’re placed on medication, the choice of medication will be based on your age, sex, ethnicity, mobility, existing health profile and other considerations.
4. You mentioned I could have a heart attack or stroke from this?  How would I know if that’s happening?  Check here for Heart Attack Recognition and here for Stroke Recognition, where I discuss signs and symptoms.  Remember, time is tissue, meaning you must not delay if you develop these symptoms.
5. What else can I do?  Be healthy!   Don’t smoke, limit alcohol intake and lower your stress level.  It’s only a broken record if you’ve received the message and have implemented the recommendations.
Speaking of broken records, see you tomorrow…
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0 thoughts on “Straight, No Chaser: 5 Questions on High Blood Pressure You Must Be Able to Answer

  1. Dr. Sterling I read somewhere that if you can lose 10% of your body weight then you can be taken off of high blood pressure and diabetes meds. Can you explain this?

    1. Hi, Stephanie. The principle is correct, but the numbers aren’t quite that exact. The point is in most cases, appropriate diet and exercise will make you healthy enough that your blood pressure will be under control to begin with. Unfortunately, in a country as obese as ours has become (stay tuned), being healthy and in shape are now a less common occurrence instead of being the rule. I’ll discuss diabetes as a separate consideration later. Thanks for the great questions. Keep them coming!

  2. What would cause the systolic to be consistently low? (54, 65)
    What is considered too low?
    Is there something to do at home to help, on the days the systolic is below 70?
    Thanks for addressing this issue.

    1. Hi, Darla. Are you sure you mean the systolic? That’s the top number. A systolic of 54 is pretty consistent with shock, meaning you’re so depleted of fluids that you’re most likely passed out. That level of low blood pressure would require an emergency visit to the ER. Even if it proved to be an adverse event from medications, running a pressure that low means sufficient ‘pump’ isn’t in place to push fluids around body. That’s a good way to get a stroke or heart attack. Thanks for the question.

        1. An isolated diastolic blood pressure (DBP) by itself is not how we assess you. A blood pressure (BP) of 110/54 would be beautiful, likely reflective of controlled BP. One of 70/54? Not so much, as that person could be in dehydrated, in shock or at risk for a blackout. On the other hand, a DBP over 110-115 is not good, as it is suggestive of a pressure high enough to potentially cause damage to your kidneys, heart or brain. Thanks for your question.

    2. All of that said, we strive for ‘slow and low’. If you’re really in shape, your heart muscle is very efficient, meaning it can deliver a forceful contraction with not a lot of effort (relatively low BP) and a lot of volume with each pump and not needing to compensate with additional pumps (therefore, slow heart rate). A systolic pressure of 100 to 115 is a very good thing.

  3. My heart rate is about 60 beats per minute, which is on the low side. The only reason that I know that it is on the low side is because every time I go to the doctor they tell me that they don’t usually see heart rates that low, unless they are in athletes that are in top condition…….which I a not. My blood pressure is also really low around. Does these two things have anything to do with one another?

    1. Hi, Stephanie. Assuming you’re not on medication for blood pressure and not known anything about your height, weight or medical history, it’s difficult to speak to your specific situation. In general, those vital signs would be signs of a healthy individual. I can only assume you’re dieting, exercising and reading Straight, No Chaser every day! Thanks for the question.

    1. Hi, Finding God Daily. Absolutely! Unfortunately, it doesn’t happen nearly as often as it could because the medication sometimes becomes a crutch and demotivates patients from vigorously attacking the blood pressure. Frankly, the same habits that get some hypertensive, keeps them hypertensive, on medication, and uncontrolled while on medication. Good luck, thanks for your question, and thanks for following Straight, No Chaser.

  4. I had bp of 263/134 and a mini stroke followed, I had to have carotid surgery. They are happy with my bp at average 115/63. I have load 30 pounds, eat healthy and exercise a little (op was 6 weeks ago). My pulse is 57 at highest and 47 at lowest. I am still 30 pounds overweight at 57 years old. I have also stopped smoking and drinking. I have been on meds for 5 march and 3/4 of the day I’m fine but part of the day I feel really I’ll. My eyes hurt and I have a terrible weakness in my head, my Dr don’t seem to take notice. BTW also on 1.25 beta blocker, do you think I’m over medicated?

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