What Should Your Blood Pressure Be? Part I
Updated April 11, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Not too long ago I had published a post concerning the newest blood pressure guidelines. In essence, the blood pressure goals were raised in contrast to prior guidelines. This has caused a lot of consternation and confusion for both physicians and patients alike. The experience of many patients has been that with the newest guidelines s/he may receive different answers from health care professionals concerning what their "optimal" blood pressure should be.
The best answer I can give you is know thyself and know thy doctor. If you have a longstanding relationship with your doctor, s/he knows you, your nuances, and how you feel at a certain blood pressure.. What the new guidelines have done is, however, is they have made everyone re-look at their blood pressure goals and have more fruitful discussions with their doctor about their ow care. Being engaged and conversant with your doctor is great. Patients are coming in being proactive and asking "Shouldn't my blood pressure be higher?"
Certain acute conditions demand a certain blood pressure. There are are also chronic medical conditions that will demand a higher blood pressure. I wanted to look at a few common clinical issues that doctors often encounter, both inpatient and outpatient to try and give you a better idea as to what your blood pressure should perhaps be:
* If you have a history of an aneurysm your blood pressure goal should be 120s/70s rangwe if you tolerate. If you are a male between the ages of 65 and 75 with a history of high blood pressure with a history of tobacco abuse, some of the essential screening that you need to is to have an ultrasound of your abdomen to evaluate for an abdomen.
In general when an aneurysm is > 6 cm surgeons will recommend surgery as the risk of spontaneous rupture (or aortic dissection) increases when it i greater than 6 cm.
* If you are in the hospital with an acute aortic dissection, the doctors definitely want your blood pressure in the 120/70 range with a pulse in the 50s-60s. Medications that are used can include Labetalol or the combination of a calcium channel blacker with a beta blocker to slow down the heart rate.
* If you have a history of a stroke, you try and lower your blood pressure as tolerated. If you have had a history of a stroke or a history of microvascular disease (clogging of the small blood vessels of the brain), then you may need a higher blood pressure to make sure that the brain gets perfused (ie, it gets the blood flow or blood pressure that it needs). Many studies, including the once reference below point to a least 140/90. Many doctors will talk to their patients about keeping their blood pressures in the low 130s for a top number and 80s for a bottom number as long as the person "tolerates."
There are blood pressure goals but the person also has to be considered in defining a "goal blood pressure" for that individual.
* If you are having an acute stroke, you really need a higher than "normal" blood pressure. In the setting of an acute stroke in the hospital, doctors will not drop your blood pressure to "normal." An acute stroke can cause there to be higher than normal pressures in the brain and a higher systemic blood pressure is needed to keep the blood flowing to the brain. Actually, as a reflex the brain can drive the systemic blood pressure up in order to keep the blood flowing to the brain. In many cases during an acute stroke, the doctors in the first 24-48 hours try to keep the blood pressure 180/100 mmHg. This is done purposely in a hospitalized setting in a controlled environment, usually in an ICU.
* If you have diabetes with diabetic neuropathy, then you definitely need a higher blood pressure. If your sitting blood pressure is high, but you stand up ad your blood pressure drops significantly because of autonomic neuropathy, then you are going to need a higher blood pressure. In that situation, trying to maintain a blood pressure in the 120s-130s will increase the risk of person falling down every time you try and stand up.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Not too long ago I had published a post concerning the newest blood pressure guidelines. In essence, the blood pressure goals were raised in contrast to prior guidelines. This has caused a lot of consternation and confusion for both physicians and patients alike. The experience of many patients has been that with the newest guidelines s/he may receive different answers from health care professionals concerning what their "optimal" blood pressure should be.
The best answer I can give you is know thyself and know thy doctor. If you have a longstanding relationship with your doctor, s/he knows you, your nuances, and how you feel at a certain blood pressure.. What the new guidelines have done is, however, is they have made everyone re-look at their blood pressure goals and have more fruitful discussions with their doctor about their ow care. Being engaged and conversant with your doctor is great. Patients are coming in being proactive and asking "Shouldn't my blood pressure be higher?"
Certain acute conditions demand a certain blood pressure. There are are also chronic medical conditions that will demand a higher blood pressure. I wanted to look at a few common clinical issues that doctors often encounter, both inpatient and outpatient to try and give you a better idea as to what your blood pressure should perhaps be:
* If you have a history of an aneurysm your blood pressure goal should be 120s/70s rangwe if you tolerate. If you are a male between the ages of 65 and 75 with a history of high blood pressure with a history of tobacco abuse, some of the essential screening that you need to is to have an ultrasound of your abdomen to evaluate for an abdomen.
In general when an aneurysm is > 6 cm surgeons will recommend surgery as the risk of spontaneous rupture (or aortic dissection) increases when it i greater than 6 cm.
* If you are in the hospital with an acute aortic dissection, the doctors definitely want your blood pressure in the 120/70 range with a pulse in the 50s-60s. Medications that are used can include Labetalol or the combination of a calcium channel blacker with a beta blocker to slow down the heart rate.
* If you have a history of a stroke, you try and lower your blood pressure as tolerated. If you have had a history of a stroke or a history of microvascular disease (clogging of the small blood vessels of the brain), then you may need a higher blood pressure to make sure that the brain gets perfused (ie, it gets the blood flow or blood pressure that it needs). Many studies, including the once reference below point to a least 140/90. Many doctors will talk to their patients about keeping their blood pressures in the low 130s for a top number and 80s for a bottom number as long as the person "tolerates."
There are blood pressure goals but the person also has to be considered in defining a "goal blood pressure" for that individual.
* If you are having an acute stroke, you really need a higher than "normal" blood pressure. In the setting of an acute stroke in the hospital, doctors will not drop your blood pressure to "normal." An acute stroke can cause there to be higher than normal pressures in the brain and a higher systemic blood pressure is needed to keep the blood flowing to the brain. Actually, as a reflex the brain can drive the systemic blood pressure up in order to keep the blood flowing to the brain. In many cases during an acute stroke, the doctors in the first 24-48 hours try to keep the blood pressure 180/100 mmHg. This is done purposely in a hospitalized setting in a controlled environment, usually in an ICU.
* If you have diabetes with diabetic neuropathy, then you definitely need a higher blood pressure. If your sitting blood pressure is high, but you stand up ad your blood pressure drops significantly because of autonomic neuropathy, then you are going to need a higher blood pressure. In that situation, trying to maintain a blood pressure in the 120s-130s will increase the risk of person falling down every time you try and stand up.
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