Medicine Talk

The Blood Pressure Rebellion

Ideal blood pressure for most adults is under 135 for the top number (systolic, or heart's maximum pump pressure), and under 85 for the lower number (diastolic, or heart resting pressure). There are exceptions. For those with prior heart attack, stroke, diabetes (Type 1 or 2), or chronic kidney disease, that value is below 130/80. In fact, many doctors would say the lower the pressure the better, so long as a person does not feel dizzy or faint. This rule may not apply to frail elders who may need higher pressures for proper brain, heart, and kidney function.

My male patients usually get a bit nervous when I tell them that uncontrolled blood pressure, even "mildly elevated," can lead to erectile dysfunction all by itself, even in men under 50. Better to spend energy to lower readings now to preserve sexual function for the future, eh?

What can people with high blood pressure do to take more control over this situation? Join our "rebellion," armed with information and self-care approaches. Here is what I would suggest for starters:

1.  Know your target blood pressure goal and write it down.
If you are not at goal, ask your doctor what will be done about this. Every visit! Allowing someone who is above target range to go three to six months on the same regimen before the next checkup is not excellent medical care.

2.  Buy and use a decent home blood pressure monitor.
Drugstore machines, local fire stations, CHR's, and trained neighbors or friends may be able to help. And, if you find a lonely cuff hidden away in a closet of a relative, as I did recently with my mother, encourage your loved one to use it.

3.  Bring your readings in writing to your office visits.
This promotes better decision making on the part of your doctor. Some people really do have "white coat hypertension" when pressure is measured in a medical setting. We use the highest reading, if both arms are being checked.