Thursday, December 10, 2015

How Low Should My Blood Pressure Be?

Recently, news outlets reported on a recent medical study (the so-called SPRINT trial) suggesting a goal blood pressure of under 120/80.

While not a bad idea, the question of just what is a good blood pressure is a bit more nuanced.

The first, higher pressure is the systolic blood pressure (SBP).  This is the pressure in your arteries when your heart is actually pumping.  The second, lower number is the diastolic blood pressure (DBP).  This is the "standing pressure" when your heart is filling with blood.

Generally, a high SBP can cause problems involving larger arteries: cardiac arrest, heart attack and stroke.  A high DBP (even if the SBP is okay) can cause problem involving smaller arteries: retinal problems, kidney disease, circulation problems to the feet.  Also, elevated blood pressure is associated with erectile dysfunction and Alzheimer's disease.

The goal of treating blood pressure is to reduce the risk of any of these things from happening to you, while also avoiding negative consequences of treatment or over-treatment.  Something the recent SPRINT trial noted was fewer heart attacks with blood pressures of 120/80 compared to 140/90.  However, there was also a significant occurrence at blood pressures of 120/80 or less of side-effects of blood pressure drugs such as abnormal electrolyte levels, abnormal kidney function, dizziness and fainting.

Medical studies that look more closely at both upside and downside risks are referred to by doctors as the Eighth Joint National Committee (JNC 8).

Goal blood pressure in patients 60 years old or older is 150/90 or less.  In patients with diabetes or chronic kidney disease, the goal is 140/90 or less.  Mind, if you are on medication and your blood pressure is 120/80 and you are not having any problems with it that's okay.  We simply are careful to avoid over-treating blood pressure as well as under-treating it.

Also, this should not detract from methods of lowering your blood pressure that don't involve medications: smoking cessation, weight loss, exercise and avoiding salty foods!

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