Which Blood Pressure Number Is the Most Important?

Reviewed on 5/21/2021

The blood that flows through the arteries (blood vessels carrying blood from the heart to other parts of the body) exerts pressure against the arterial walls. The number above (120) is called the systolic blood pressure and the number below (80) is called the diastolic blood pressure. Though both readings are important, many doctors believe that systolic blood pressure is a better predictor of complications of hypertension, such as heart disease or stroke.
The blood that flows through the arteries (blood vessels carrying blood from the heart to other parts of the body) exerts pressure against the arterial walls. The number above (120) is called the systolic blood pressure and the number below (80) is called the diastolic blood pressure. Though both readings are important, many doctors believe that systolic blood pressure is a better predictor of complications of hypertension, such as heart disease or stroke.

The blood that flows through the arteries (blood vessels carrying blood from the heart to other parts of the body) exerts pressure against the arterial walls. A predetermined range of this “blood pressure” is generally maintained by the body. Certain triggers may increase this blood pressure. Persistently elevated blood pressure (hypertension) may damage the heart, kidneys, brain and even the eyes.

When the blood pressure is measured, the result gives two numbers. For example, the blood pressure result is 120/80 mmHg. The number above (120) is called the systolic blood pressure and the number below (80) is called the diastolic blood pressure. The systolic blood pressure reflects the pressure over the heart, whereas the diastolic blood pressure reflects the status of the blood pressure. Though both readings are important, many doctors believe that systolic blood pressure is a better predictor of complications of hypertension, such as heart disease or stroke.

There is a strong correlation noted between the deaths due to heart disease and systolic blood pressure. The measurement of only the systolic blood pressure predicts the heart risk better than the diastolic blood pressure. In elderly people, isolated systolic hypertension is the most frequent form of elevated blood pressure seen.

How is blood pressure (hypertension) classified?

See Table 1 to know about the classification of hypertension.

Table 1. Classification of hypertension based on office blood pressure (BP) measurement (Source: JNC 9 hypertension guidelines 2020)

Category          Systolic (mmHg)         Diastolic (mmHg)       Management       
Normal BP  Lesser than 130  Lesser than 85  N/A
High-normal BP  130-139  85-89  Lifestyle and diet modifications
Grade 1 hypertension  140-159  90-99  Single drug, and lifestyle and diet modifications
Grade 2 hypertension     Greater than or equal to 160  Greater than or equal to 100   Double drug combination, and lifestyle and diet modifications

What is home blood pressure monitoring?

Home blood pressure monitoring is done using an automated blood pressure device (which has been checked for accuracy in the clinician's office). A person can take multiple readings over several consecutive days at different times. Mild elevations and dips in the blood pressure throughout the day are normal. A person can take two to four readings daily for seven days before scheduling an appointment. These readings help doctors estimate and manage blood pressure spikes better. It is important to observe the following precautions before taking blood pressure readings at home:

  • Relax and sit comfortably in a chair.
  • The cuff is applied to the arm. The arm should be well supported over a table or the arms of the chair.
  • Avoid drinking tea or coffee or smoking cigarettes 30 to 40 minutes before taking blood pressure readings.
  • Take readings at the same time each day and on the same arm.

What lifestyle modifications are advised for people with high blood pressure?

The following lifestyle modifications are advised:

  • The low sodium, DASH (dietary approach to stop hypertension) diet is recommended to manage and treat hypertension.

Table 2. DASH diet composition

 Salt          Less than 1500 milligrams (mg) of sodium a day.        
 Whole grains (six to eight servings a day)

 Whole wheat bread, cereal, brown rice and whole-grain pasta. Examples of one serving of grains include

  • 1 slice of whole-wheat bread
  • 1 ounce of dry cereal
  • 1/2 a cup of cooked cereal, rice or pasta

Vegetables: four to five servings a day

(includes both fresh and frozen vegetables)

 Tomatoes, carrots, broccoli, sweet potatoes, greens, pumpkins, squash, brinjals and leafy vegetables.
 Fruits: four to five servings a day   All fruits can be eaten as per seasonal availability.
 Lean meat, poultry and fish
 (six one ounce servings or fewer a day)
 Egg whites (boiled), fatty fishes, such as salmon and mackerel, sea cod and grilled chicken.
 Nuts, seeds and legumes (four to five servings a week)  Almonds, sunflower seeds, kidney beans, peas and lentils are good sources of magnesium, potassium and   protein.
 Fats and oils to be limited to two teaspoons a day  Limit your intake of red meat, butter, cheese, whole milk, cream and egg yolk along with the foods made     from lard, solid shortenings and palm
  • Maintain hydration: Drink six to eight glasses of water daily and other fluids, such as green and black tea, hibiscus tea, pomegranate juice and beetroot juice also helps keep blood pressure under control.
  • Maintain ideal body weight: Recommended as per a person’s height.
  • Control addictions: Smoking and alcohol cessation are essential to maintain healthy blood pressure.
  • Exercises: Walking daily for 30 minutes or doing other physical activity like cycling or swimming helps keep the heart healthy.
  • Practice stress management: Mindfulness or meditation introduced into the daily routine via yoga, Tai Chi or breathing exercises goes a long way to control blood pressure spikes.

QUESTION

Salt and sodium are the same. See Answer

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References
Medscape Medical Reference

Current Opinion in Nephrology and Hypertension


Journal of Hypertension: Supplement


Hypertension


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