What is considered normal blood pressure?

If you are like me, you continue to be confused about what constitutes high blood pressure.  It seems as though for years 120/80 for all people was considered “normal” blood pressure and those people with blood pressure readings above 140/90 were considered to have “essential hypertension” necessitating the use of blood pressure medications and avoiding dietary salt to lower it.

In the past several years there have been numerous blood pressure studies looking at blood pressure levels and death rates for each level.  The latest study called “SPRINT” (a funny acronym since it stands for Systolic HyPertension INtervention Trial and not “S.H.I.T.” trial) studied people over 50 years old with at least one cardiovascular risk factor (documented peripheral, coronary or cerebral disease or a 10-year risk of heart attack greater than 15%.)

This study found that goal blood pressure should be less than 125 systolic (top number) and 90 diastolic (bottom number) for people over 50 years of age AND 10-year risk of heart attack greater than 15%.  This is different from a study before this suggesting 140/90 as the goal blood pressure.

Experts working with seniors (greater than 80 years old) continue to recommend only treating the systolic blood pressure (top number) if they have cardiovascular risk factors BUT making sure that the diastolic (bottom number) is GREATER THAN 60.  Seniors deal with dramatic changes in blood pressure from sitting to standing that increase fainting and   I am not sure there will be a definite blood pressure goal for people over age 80 as there are too many other confounding factors and there are not many octogenarians enrolled in these blood pressure studies.  My recommendation is to use blood pressure readings from a manual cuff (not an automated blood pressure machine) and check the blood pressure laying, sitting and standing (wait 1 minute between readings).  If your blood pressure drops by more than 20 points between readings then it may be a good idea to not over treat your blood pressure.

What if you have no increased risk factors and less than 80 years old?  This is where the waters get really muddy: no one can agree on a number at this time.  The closest that I can recommend is to say that less than 150 for the systolic (top number) and less than 90 for the diastolic (bottom number) and this is based on a study done a few years ago showing a “J” type curve for blood pressure control versus death rate: the “J” comes from an increase in death rate if your blood pressure is too low as if it is too high.