What Do I Need To Know About Blood Pressure? The Basics, Made Simple!
Prevention 101: Know your numbers! Know your blood pressure.
Why? There is a continuous association between higher blood pressure and increased cardiovascular disease risk. The 2017 ACC/AHA/ABC guideline for prevention, detection, evaluation & management of high blood pressure in adults outlines how we diagnose high blood pressure, as well as our treatment algorithm. This is based on extensive robust data, including well done randomized controlled trials, but also includes registries, nonrandomized comparative & descriptive studies, case series, cohort studies, systematic reviews & expert opinion.
Blood pressure is categorized into 4 levels on the basis of average BP measured in a healthcare office setting: normal, elevated, & stage 1 or 2 hypertension.
Normal blood pressure is considered <120/80. For individuals with normal blood pressure, we recommend reassessing every year .
Elevated blood pressure is considered 120–129/80. This is a Class 1 indication for lifestyle modification! For individuals with elevated blood pressure, we recommend reassessing in in 3–6 months.
❗️Stage 1 Hypertension is considered with systolic blood pressure 130–139 OR a diastolic blood pressure of 80–89. If you already have clinical atherosclerotic cardiovascular disease, this is a Class 1 indication for both lifestyle modification and blood pressure lowering medication.
❗️In patients with Stage 1 Hypertension (systolic blood pressure 130–139 OR a diastolic blood pressure of 80–89) but without clinical atherosclerotic cardiovascular disease, this is a Class 1 indication for lifestyle modification, and the patient can wait on starting meds for 1 month, and attempt to improve their blood pressure with dietary modification, exercise, and smoking cessation. For individuals with Stage 1 Hypertension, we recommend reassessing in 1 month.
❗️Stage 2 Hypertension is considered with systolic blood pressure >140 OR a diastolic blood pressure >90. This is a Class 1 indication for both lifestyle modification and blood pressure lowering medication. For individuals with Stage 2 Hypertension, we recommend reassessing in 1 month.
The rationale for this categorization is based on observational data related to the association between blood pressure and heart disease risk, RCTs of lifestyle modification to lower BP, and RCTs of treatment with antihypertensive medication to prevent cardiovascular disease. The increased risk of CVD among adults with stage 2 hypertension is well established. An increasing number of meta-analyses have reported a gradient of progressively higher cardiovascular risk going from normal BP to elevated BP & stage 1 hypertension.
Know your numbers
“HOW do I measure my BP at home!?”
Lets discuss home blood pressure monitoring (HBPM) (not to be confused with ambulatory blood pressure monitoring, ABPM, which we will cover another time)
How do we ensure that patients get the best home blood pressure measurement?
How you prepare for the test, the position of your arm, and other factors can change a blood pressure reading by 10% or more!
Automated devices >> auscultatory devices. This is because checking a manual blood pressure takes medical training and technique, and automated devices are more reliable for patients.
Validate your cuff at your doctors office, or a pharmacy. Bring your cuff with you to your doctors office, or a pharmacy (CVS has free BP readings available!) and make sure that your readings match up.
Memory: get an automated cuff that stores your readings (or transmits results to your phone via bluetooth)
Cuff size: make sure you have the right fit!
Now we are ready to start checking our BP:
Avoid smoking, caffeine, or exercise 30 min before, and have at least 5 minutes of rest right before checking.
Back straight and supported.
Feet flat on the floor and legs uncrossed
Keep your arm supported on a flat surface, upper arm at heart level!
Bottom of the cuff should be right above the bend of the elbow.
Take multiple readings!
Take at least 2 readings, 1 min apart in the am (before meds) and at night before dinner.
Ideally: we want patients to measure and record their BP at daily (sometimes twice a day!)
Bring your monitor with the blood pressure readings to your clinic visit!
This really helps us tailor your blood pressure treatment, more accurately and reliably.
This ALSO helps us sort out different diagnoses: whether you have true sustained hypertension, masked hypertension, or white coat hypertension.
Dr. Belardo is a cardiologist in a multidisciplinary practice in Newport Beach, California. Dr. Belardo sees patients for cardiovascular disease, preventive cardiology, advanced lipidology, cardiometabolic health, and weight loss. She is the co-chair of the American Society of Preventive Cardiology Nutrition Committee, a member of the American College of Cardiology Nutrition and Lifestyle Committee, and the Communications Catalyst for the California Chapter of American College of Cardiology.
Learn more about Dr. Belardo by clicking here
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