Which is more important - systolic or diastolic blood pressure?

It’s important to control both systolic and diastolic blood pressure. For many years doctors focused mostly on the diastolic blood pressure (the “bottom” number). However, studies have found that in people over age fifty, a high systolic blood pressure is more closely related to heart disease, stroke, kidney disease, and death. People know now that it is best to pay attention to both.

What if I have trouble only with my systolic blood pressure?

Many people have normal diastolic pressure but hard-to-control systolic pressure. This is especially common among older adults. Thiazide diuretics (for example, hydrochlorothiazide or HCTZ) and calcium channel–blockers have been shown to work especially well in these situations.

But other medications can also work for people who have high systolic blood pressure, and so it is generally recommended that the same approach to lowering blood pressure overall be used for people with hard-to-control systolic pressure.

Can a blood pressure be too low?

While blood pressure that’s too high is dangerous, low blood pressure also can cause symptoms, though typically not dangerous ones. If your blood pressure is too low, you may feel dizzy, tired, or weak. This usually does not happen until the systolic blood pressure goes below 100 mmHg. If you have these symptoms, you should definitely talk with your doctor about them. Many people have even lower blood pressure without any symptoms.

What about calcium, potassium, or magnesium supplements?

No medical consensus has emerged yet to support taking any of these supplements to lower blood pressure. The few studies that favor taking supplements are not scientifically strong. What we do know is that not having enough of these nutrients in your regular diet may increase your blood pressure.

So, to optimize your overall health as well as your blood pressure level, you should ensure you are incorporating adequate amounts of these nutrients into a healthy balanced diet.

What about ephedra?

Ephedra, the herbal compound also known as “ma huang,” is an ingredient in some weight-loss supplements. It is closely related to ephedrine and pseudoephedrine, medications contained in some decongestants, bronchodilators, and stimulants.

Concerns have been raised about the potential for these drugs to cause hypertension, heart attack, and stroke. The Food and Drug Administration (FDA) banned dietary supplements that contain ephedra. However, the ban excludes the use of the herb in traditional Asian medicine.

The FDA ruling considers herbal medicine preparations beyond the scope of its authority. As a result, ephedra will not disappear. Therefore, if you already have high blood pressure, diabetes, or heart disease, you should not take medications containing ephedra. If you regularly use herbal medicines or tea, you should check to see if they contain ephedra.

What about caffeine?

Caffeine may increase your blood pressure right after you drink it, which is why you should avoid caffeine before having your blood pressure measured. But drinking a lot of caffeine has not been shown to raise your blood pressure over the long term.

Is high blood pressure harder to control in Africana Americans?

For reasons that we do not yet fully understand, hypertension develops earlier in African-Americans, and their average blood pressure tends to be higher. African-Americans have higher rates of Stage 2 hypertension and therefore are more prone to complications.

The good news is that the combination of lifestyle changes and medication works just as well to reduce blood pressure for African-Americans as for everybody else. In fact, studies show that the DASH Diet is even more effective in African-Americans than in others.

The diet alone works as well to treat Stage 1 hypertension as using a medication. Some studies suggest that certain medications, such as ACE inhibitors and ARBs, are not as effective in African-Americans as they are in others.

However, these studies are considered controversial and you should know that current expert consensus is that all blood pressure–lowering medications work for African-Americans. As with all patients, what is important is to be persistent in treating high blood pressure and to monitor the effects of therapy.

Does stress cause high blood pressure?

Blood pressure tends to go up when we are stressed and then go down when we are relaxed. Being stressed on a frequent or chronic basis may have something to do with developing hypertension, but the data are not definitive. Some researchers have theorized that including stress-management techniques or quiet periods of meditation in your daily or weekly routine may help to lower blood pressure, along with other heart problems.

If stress is a problem for you, stress-management techniques may help you feel better and will likely pose no harm, so this approach may be worth a try. However, the jury is still out on whether or not they can substitute for the other lifestyle and medication treatments in managing your blood pressure.

What is "White coat hypertension”?

If your blood pressure is high every time it is measured in your doctor’s office or similar medical setting, but low whenever it is measured anywhere else, you may have what is called “white coat hypertension.” Some people become anxious in a doctor’s office and their blood pressure rises.

While some experts question the concept of white coat hypertension, the prevailing belief is that the stress that causes it is real—and that people who experience it experience it at other stressful times as well. Therefore, many experts currently recommend that people with white coat hypertension be treated like other people with high blood pressure.

What is “Ambulatory blood pressure monitoring”?

Ambulatory blood pressure monitoring, sometimes called ABPM for short, is a test in which a patient wears a blood pressure–measuring device continuously for a twenty-four-hour period to record blood pressure throughout the day and night.

This test is often used to evaluate white coat hypertension, but it can also be used to investigate hypertension that does not seem to respond to medication, blood pressure that drops too low during medication treatment, and blood pressure that appears to fluctuate with unusual patterns.

How often should I monitory my blood pressure?

When you are having your medications changed, you should have your blood pressure monitored every few weeks. Once your blood pressure has stabilized, you can measure it less frequently, but many people find that frequent measurements help them to maintain their motivation. The only caveat is that blood pressure can vary from day to day.