Dr. Edward Mostel has been a cardiologist for more than 20 years, so he remembers when the bar for high blood pressure was equal to your age plus 100.
A 70-year-old with a blood pressure of 170 (as in 100 plus 70) over 90 wasn't cause to worry; it was a matter of age.
Then research advanced and the line crossing into hypertension fell to 140 over 90.
"But more and more we're realizing even that's not correct," Mostel said.
These days, you may feel like breathing a sigh of relief when the nurse announces your numbers are 135 over 87 - don't.
Because these days, while you don't have the textbook definition of hypertension, you do have "prehypertension."
Time to check your salt intake and invest in walking shoes.
You say those numbers hop up only when you step into the doctor's office, a condition called "white coat hypertension"?
About one in six adults actually has white-coat hypertension, a 2009 study in the American Heart Association Journal concluded. But you're not off the hook if one of them is you.
In fact, your chances of developing full-blown hypertension down the road are so dramatically higher than your neighbor's, that your doctor wants to take a closer look at your diet, too.
"As we learn more, we realize we've been wrong," said Mostel, a cardiologist with Palm Beach Cardiology Center. "They've found there's a linear relationship between blood pressure and heart attacks and strokes."
That means that as either the top number or bottom number rises over the "normal" 120 over 80, so does your risk of dying from the problems high blood pressure fuels.
Why blood pressure matters
Before we get your blood pressure going, let's first review what it is and why you should care.
Blood pressure is the measure of the force of your blood against the walls of your arteries.
It is expressed by two numbers: The one on top, the systolic pressure, is the pressure when the heart beats.
The bottom number is diastolic pressure when the heart is between beats.
The clinical definition of hypertension is 140/90 . Over time, your risk for heart attack and stroke is greater than a normal reading of 120/80.
And you might not feel a thing until the damage is done, said Dr. Rute Paixao, a nephrologist with the Cleveland Clinic in West Palm Beach.
What if your blood pressure is steadily registering higher than normal, but you're not hypertensive?
The good news is that medicine is not the first resort. The bad news, for most Americans, is that lifestyle change is.
"I've had patients who've adjusted their lifestyle, stopped smoking, ate less salt," said cardiologist Dr. Lawrence Weinstein.
But
"Lifestyle changes are extremely difficult," Weinstein said. "I like them to take baby steps. If the project is huge it can seem overwhelming."
So he has patients start cutting back on salt by eliminating it from their home cooking.
"For exercise, I say try walking 30 minutes a day. It's not the speed, it's not the distance. And good habits, any habit, takes about three weeks to change."
If they fail, and statistics show that many do, then the alternative is medication, potentially a lifetime of it.
Paixao is willing to wait for change, but for only so long - maybe a year, she said.
Looking beyond blood-pressure numbers
And then doctors and patients come to the next question: How low should they aim?
"The whole thinking of treating hypertension is at a crossroads right now," Weinstein said. "Where we treat, what we treat and our goals in treatment are in flux."
And doctors have to refer to more studies. A simple increase of 20 points systolic or 10 points diastolic can double your risk of death, but other studies indicate that the benefits, for example, of getting diabetics under 140 vs. under 120 might not be significant.
Paixao said she's found that some of her older patients have more energy when they don't increase their medication to aim for under 120.
The best plan is to not just monitor the pressure but run checks to look for damage to the heart or kidneys, she said.
"I definitely believe in educated patients," she said, "because if you understand what is wrong, it's easier to accept and do better."
If blood pressure is too high:
You can damage arteries, leading to aneurysm.
You can strain your heart, leading to heart failure.
Over time, you can damage your brain, your kidneys or your eyes.
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