Managing Your Blood Pressure

Dr. Merle Myerson with patient

Blood pressure is the force of circulating blood as it flows through the body’s arteries. The arteries are the vessels that take blood out of the heart and through the body to bring oxygen to the body’s organs and muscles. Low blood pressure leads to weakness and dizziness. High blood pressure, or hypertension, increases the risk of heart attack, stroke, coronary artery disease, vision issues and kidney disease.

Dartmouth-Hitchcock Heart & Vascular Center Cardiologist and Lipidologist Merle L. Myerson, MD, PhD, offers important information about blood pressure and how to manage it to support heart and overall health.

What is a “good” blood pressure?

In 2017, the American Heart Association published new guidelines for blood pressure levels that research shows are beneficial to all age groups and genders. The optimal blood pressure is under 120/80. The “top” number is the systolic pressure, or the pressure of blood flowing through the arteries when the heart contracts. The “bottom” number is the diastolic pressure, or the pressure in the arteries as the heart relaxes and blood returns from the body to the heart.  

While 120/80 is considered optimal, some patients, in particular those who are older, may not tolerate a blood pressure in that range. It is important to discuss your blood pressure goal with your provider.

Are there recognizable hypertension symptoms?

Some patients might experience headaches or have a hard time breathing but, in general, hypertension is very hard to notice. It’s actually called the “silent killer.” That’s why it’s so important to measure blood pressure at doctor visits or at home.

At-home blood pressure monitors with arm cuffs are more accurate than those with wrist cuffs. Patients who use an at-home monitor should bring it to a doctor visit and validate its accuracy.

How is blood pressure managed?

Lifestyle changes are important for all high blood pressure patients. The DASH (Dietary Approaches to Stop Hypertension) diet which emphasizes fruits, vegetables, low-fat dairy, whole grains, fish, poultry and nuts and reduces fats, red meats, sweets and sugary drinks has been shown to offer benefit similar to medications.  For some patients, diet and other lifestyle modifications can bring blood pressure to goal without medications but all patients should work on making these changes.

Reducing sodium intake also helps lower blood pressure. I advise patients to read ingredient labels when shopping. An item that contains a high percent of the recommended daily amount of sodium in one serving should stay on the shelf. And, it’s good to stop using the salt shaker.

Exercise, maybe just walking 20 to 30 minutes a day, helps reduce weight and blood pressure as does reducing alcohol consumption. Stress also increases blood pressure. Some patients can use bio-feedback—tighten up their body and then breathe out and relax—to reduce their stress.

When is medication necessary?

When lifestyle changes aren’t enough to lower blood pressure to the optimal level, medication is prescribed. Primary care physicians often prescribe medications in a group called “ACEI and ARB,” diuretics—often called water pills—and calcium channel blockers. If those medications aren’t effective, patients typically see a specialist who looks for a secondary cause of hypertension and prescribes other medications.

Any last words of advice?

It’s important to know your numbers and review them with your health care provider to discuss a plan for management and treatment, if indicated. Blood pressure treatment is not one-size-fits-all. Your provider will help you adjust diet and exercise and prescribe medication that fits your overall lifestyle and health.

For more information on managing your blood pressure, visit the Dartmouth-Hitchcock Heart & Vascular Center's website