Blood Pressure Part 1 - Medicine With Heart

Blood Pressure: An Introduction

Blood pressure is one of the most crucial and simultaneously most frequently forgotten and ignored components of reducing disease risk and achieving optimal health. High blood pressure (hypertension) can lead to a wide range of serious diseases, including:

Heart attack or stroke
Aneurysm
Heart failure
Kidney problems
Eye problems
Metabolic syndrome
Changes with memory or understanding
Dementia

Considering the serious and potentially fatal consequences of hypertension, the World Health Organization statistics regarding this condition are alarming.

An estimated 1.28 billion adults aged 30–79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries
An estimated 46% of adults with hypertension are unaware that they have the condition.
Less than half of adults (42%) with hypertension are diagnosed and treated.
Approximately 1 in 5 adults (21%) with hypertension have it under control.
Hypertension is a major cause of premature death worldwide.
One of the global targets for noncommunicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.

In the United States, statistics around hypertension are even less encouraging than those regarding global trends.

In survey period 2017–2018, the prevalence of age-adjusted hypertension was 45.4% among adults and was higher among men (51.0%) than women (39.7%).
Hypertension increased with age: 22.4% (aged 18–39), 54.5% (40–59), and 74.5% (60 and over).
Hypertension prevalence was higher among non-Hispanic black (57.1%) than non-Hispanic white (43.6%) or Hispanic (43.7%) adults.
Hypertension was lowest among college graduates compared with those having a high school education or less, and those with more than high school or some college. This trend was similar among both men and women.
Overall hypertension prevalence decreased from 47.0% in 1999–2000 to 41.7% in 2013–2014 and then increased to 45.4% in 2017–2018.

Considering the serious nature of hypertension and the significant level of underdiagnosis, it is truly a top global health concern.

Considering the range of concerns blood pressure dysregulation presents, in part 1 of this series, the following components will be explored:

What blood pressure is
The range of blood pressure:
- Normal
- Optimal
- Elevated
- Low
Measuring blood pressure
Devices for blood pressure measurement

What is Blood Pressure?

Blood pressure is a measurement of how much pressure or force of blood occurs inside arteries. Each time the heart beats, it pumps blood into arteries which carry blood throughout your body. This happens 60 to 100 times a minute, 24 hours a day. Arteries deliver oxygen and nutrients to your whole body so it can function.

Blood pressure is measured in two numbers: systolic and diastolic.

Systolic blood pressure is the force exerted against the arterial walls that occurs when the heart contracts.

Diastolic blood pressure is the amount of force exerted against the arterial walls as measured between heartbeats.

Blood pressure is measure in millimeter of mercury (mm Hg). Although blood pressure monitors that use actual mercury are rare in the modern era, they do still exist and were the original method for measuring blood pressure.

Maintaining systolic and diastolic blood pressure within the normal range has numerous and significant health benefits so striving to accomplish this is an important goal along the journey to optimal wellness.

Blood Pressure: Normal, Elevated, and Low

Normal Blood Pressure

Normal blood pressure is considered as a systolic pressure of less than 120 and a diastolic pressure of less than 80. This is a general target range for all adult and genders though normal ranges may be more technically defined based on age and gender.

These ranges include:

Newborns up to 1 month: 60 – 90 mm Hg/20 – 60 mm Hg
Infants: 87 – 105 mm Hg/53 – 66 mm Hg
Toddlers: 95 – 105 mm Hg/53 – 66 mm Hg
Preschoolers: 95 – 110 mm Hg/56 – 70 mm Hg
School-aged children: 97 – 112 mm Hg/57 – 71 mm Hg
Adolescents: 112 – 128 mm Hg/66 – 80 mm Hg

In adulthood, the average blood pressures by age and gender are:

18 – 39:
- Female: 110/68 mm Hg or below
- Male: 119/70 mm Hg or below
40 – 59:
- Female: 122/74 mm Hg or below
- Male: 124/77 mm Hg or below
60+:
- Female: 139/68 mm Hg or below
- Male: 133/69 mm Hg or below

Optimal Blood Pressure

Optimal adult blood pressure based on age and gender could be considered as the young adult ranges for all age ranges as this would more significantly decrease the likelihood of negative impact from blood pressure. These levels would be:

Female: 110/68 mm Hg or below
Male: 119/70 mm Hg or below

Elevated Blood Pressure

Elevated blood pressure (hypertension) is the primary concern in the realm of blood pressure and health. As previously noted, excessive pressure on arterial walls from the pressure of blood flow can lead to a wide variety of serious health conditions.

There are various stages of hypertension and the current consensus regarding the definition of hypertension includes the following:

Elevated: 120 – 129/less than 80 mm Hg
Hypertension stage 1: 130 – 139 and/or 80 – 89 mm Hg
Hypertension stage 2: 140 or higher and/or 90 or higher mm Hg
Hypertensive crisis: higher than 180 and/or higher than 120 mm Hg

Avoiding even the ‘elevated’ stage of blood pressure is important in the quest for health optimization and working to ensure an optimal range is essential for avoiding a wide range of health conditions.

Low Blood Pressure

Technically, low blood pressure (hypotension) in adults is considered a reading of below 90/60 mm Hg. There are two types of hypotension:

Absolute hypotension: resting blood pressure is below 90/60 mm Hg
Orthostatic hypotension: resting blood pressure stays below 90/60 for greater than three minutes after standing up from a sitting position. Although it normal for blood pressure to drop briefly after standing, it shouldn’t drop for longer than three minutes. The drop must be 20 mm Hg or more for your systolic (top) pressure and 10 mm Hg or more for your diastolic (bottom) pressure. Another name for this is postural hypotension because it happens with changes in posture.

Hypotension may or may not cause symptoms. In severe episodes of hypotension, emergency medical attention may be required.

Symptoms of hypotension may include:

Fainting or passing out (syncope)
Distorted or blurred vision
Fast, shallow breathing
Fatigue or weakness
Feeling tired, slugging, or lethargic
Confusion or concentration issues
Agitation or other behavior changes

Although low blood pressure is generally considered less of a long-term concern than elevated blood pressure and the primary impact may be the short-term symptoms it causes, there may be longer-term impacts caused by blood pressure that is consistently too low.

Serious impacts of hypotension may include:

- Falls and fall-related injuries. This is a significant risk with hypotension as the associated dizziness can cause fainting episodes potentially leading to broken bones, concussions, and other significant or even life-threatening injuries.
- Shock. Low blood pressure can potentially cause organ damage due to reduced blood flow. A more severe case of this is the body shutting down due to limit blood flow and oxygen to the tissues.

Cardiac issues such as heart failure and stroke. When blood pressure is too low, it may cause the heart to pump faster and/or harder to ensure the body is still receiving adequate blood flow. This can cause the heart to weaking, potentially leading to heart failure. When the blood doesn’t flow normally, it can also allow clots to form, which may lead to deep vein thrombosis and stroke.

Knowing symptoms of low blood pressure is important to allow for awareness of issues such as imminent fainting and when to sit or lay down, for example, in order to avoid a fall.

Blood Pressure: Effective Measurement

Although taking blood pressure reading (whether at home or in a doctor’s office) is a relatively common procedure, it is also unfortunately common to perform this incorrectly.

To ensure an accurate reading, the correct method for performing a blood pressure reading involves the following steps:

Do not smoke, drink caffeinated beverages, or exercise within 30 minutes prior to measuring blood pressure
Some medications and foods can increase blood pressure. These may include:
- NSAIDs
- Decongestants
- Alcohol
- Salt
Have an empty bladder as a full bladder can cause a transient blood pressure increase
Ensure the cuff fits your arm comfortably as a cuff that is too tight may show an artificially high reading
Sit in a comfortable, upright position with your back supported, feet flat on the floor and legs about hip-width apart
Place the cuff on your bare arm (without any type of clothing between the cuff and your skin). Ensure the bottom of the cuff is directly above the elbow bend.
Relax for around five minutes before taking the reading. Ideally avoid activities such as talking, cell phone use, etc. – anything that could be stimulating. Any form of stress can increase blood pressure.
Measure your blood pressure at around the same time each day to ensure consistency

Proper blood pressure measurement technique is important as it ensures as accurate a reading as possible to base care decisions upon. Most modern blood pressure monitors will track your reading automatically. If not, keep a log of blood pressure reading days, times, and levels.

Blood Pressure: Devices

There are a wide variety of blood pressure devices on the market today and most modern devices are well calibrated for accuracy. Devices are also becoming more advanced. For example, in some areas of the world, a 24-hour wrist-based blood pressure monitor is now available.

A primary consideration (aside from affordability) is finding a device that works well for you and that you will use as needed.

Types of blood pressure devices include:

Traditional mercury-based blood pressure device. These are primarily found in some doctor’s offices and not recommended for home use due to mercury content and being generally cumbersome for home testing.
Digital arm cuff monitors with connected tubing and reading device
Digital wrist-based monitors
Digital solo arm cuff monitors with integrated (tube-free) Bluetooth transmission and app
24-hour blood pressure monitors. Currently available through medical providers and hopefully over the counter at some point in the USA.

Determining the type of blood pressure monitoring device that is best for a given individual depends on comfort, affordability, and features. Finding and using an accurate blood pressure monitoring device is an important step in the process of achieving healthy blood pressure levels.

Summary

Managing and ideally optimizing blood pressure is a critical and often overlooked component of health and wellness as dysregulated blood pressure can result in a wide range of potentially serious health concerns.

In part 1 of this series, the following aspects of blood pressure have been reviewed: