Keys to Understanding & Managing Your Blood Pressure

Written by Mark A. Creager, MD, Director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, NH

Uncontrolled high blood pressure is often called the “silent killer” because you can’t feel high blood pressure, nor can you know how high it is until you measure it. And, of all the factors contributing to heart disease, and the potential for having heart disease or a stroke, high blood pressure is number 1.

    More than 30 percent of the overall adult population lives with high blood pressure—a percentage, along with the risk of heart disease, that increases as we age. Too many people do not know that they have high blood pressure, and among those who do, there are less that are being treated effectively and bringing their levels under control.

    Early identification of high blood pressure is key to maintaining good cardiovascular health, and it begins with a clear understanding of what blood pressure is, its risks and causes, and how to reasonably manage it in your daily life.

Blood Pressure Basics

 A blood pressure reading combines two measurements: the maximum, or systolic, pressure your heart creates while beating, and the pressure in your blood vessels between beats, called diastolic pressure. A blood pressure reading is reported as the systolic number “over” the diastolic, such as “120 over 70,” and commonly written as “120 / 70.”

    The American Heart Association recently updated their guidelines on what is a normal, elevated or high blood pressure:

Normal: Less than 120 / Less than 80

Elevated: 120-129 / Less than 80

Stage 1: High (hypertension): 130-139 / 80-89

Stage 2: 140 or higher / 90 or higher

Anyone with a Stage 1 or Stage 2 should speak with their provider to learn how to manage and treat their blood pressure. 

What Causes High Blood Pressure?

There is no single cause of high blood pressure. Genetics can play a role, and so can ethnicity—data shows that African Americans bear the highest risk. Other serious conditions, such as kidney or thyroid disease, can also be factors. And, as noted before, your risk grows with age and the stiffening of blood vessels.

    For many, lifestyle choices lead to high blood pressure. Among the biggest culprits is a high amount of sodium (e.g. salt) in your diet. The average person’s sodium intake in the U.S. is more than 3.4 grams. The clinically recommended intake is less than 2.3 grams of sodium per day, and ideally less than 1.5 grams for most adults.

    High-sodium foods include canned soup, salad dressings, cured hams and other dried meats, cold cuts like pastrami, bread, pizza and vegetable juice, to name a few. Read food labels to monitor your daily sodium intake.

How to Treat and Manage High Blood Pressure

Working with your doctor is the best way to bring high blood pressure under control. Together, you can determine lifestyle changes and possible medications that are right for you, and create a plan that allows you to check and report your blood pressure from home.

     In general, begin with a heart-healthy diet that is low in sodium, low in fat, and includes whole grains, fruits and vegetables. Limit the amount of alcohol you drink—to no more than one to two drinks a day—to reduce your risk.

     Exercise and (if necessary) a weight-loss program are recommended. Ask your physician if fitness or nutritional counselors are available to help you.

    Stay in regular contact with your physician. Discuss your progress, challenges and any medication side effects—not just until your first good reading, but for the weeks and possibly months it may take to regularly control your blood pressure.

Mark A. Creager, MD, is the Director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, NH. He is also the Past President of the American Heart Association and served on its National Board of Directors. 

1 Comment

  1. When are we going to teach doctors to look for Primary Aldosteronism? With current testing 6% to 13% of people with hypertension will test positive. If resistant hypertension (uncontrolled blood pressure on 3 or more medications preferably including a diuretic) that number jumps to 20%! The most common cause of hypertension in people under 40 years old. Doctors “forget to check so the patient often has to remind them.

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