How to Monitor Blood Pressure at Home & 5 Other Things to Know About Hypertension

What numbers are cause for concern?

By Merle Myerson, MD, EdD, FACC
blood pressure monitor

UPDATE: This article was updated with new and relevant medical information on June 26, 2019.

High blood pressure, also known as hypertension, is often called the Silent Killer because many people show no symptoms when their blood pressure is too high. Approximately one out of every three adults in the United States suffer from hypertension. This is why learning how to monitor blood pressure at home, interpreting your numbers, and making healthy lifestyle changes are so important to your heart health.

Hypertension is a risk factor for stroke and can cause severe damage to other organs – eyes, kidneys and the arteries that bring blood to the heart muscle (coronary arteries). Here’s how to know what’s normal, what’s not, and how to maintain your optimal health when it comes to blood pressure.

What Is a Normal Blood Pressure?

Normal or ideal blood pressure is less than 120/80 mm Hg. When the top number (the systolic number) is 120-129, a person is considered to have elevated blood pressure.” Blood pressures in this range don’t necessarily require medication and many people in this category can bring their blood pressure down with lifestyle modification, such as losing weight and reducing their salt intake.

If a person’s blood pressure is over 130/80, they are considered to have stage 1 hypertension. And if it is over 140/90, they are considered to have stage 2 hypertension. Lifestyle modifications are obviously important, but most of these people will need to be treated with medication as well, especially if they have certain risk factors like diabetes.

What Do the Numbers Mean?

There are two numbers in the blood pressure measurement. The first, or top number, is called the systolic blood pressure and represents the pressure in your arteries (the blood vessels that carry blood with oxygen from the heart to the body) when the heart contracts (beats). 

The bottom number is called the diastolic blood pressure, and represents the pressure in your arteries while your heart relaxes in-between beats. Both numbers are integral to your health and elevation in one, or both, are considered when diagnosing hypertension.

How Is Blood Pressure Measured?

Blood pressure is measured with a sphygmomanometer, more commonly called a blood pressure cuff.  The cuff is typically placed around the upper arm just above the elbow and inflated, then deflated while listening with a stethoscope over the artery in the arm. Home blood pressure machines may use a cuff attached to a machine, but without the need of a stethoscope. 

To be as accurate as possible, blood pressure should be measured after a person has sat quietly for at least five minutes and not had caffeine, tobacco or exercised for at least 30 minutes. A proper size cuff should be used. Blood pressure can be taken on either arm and is often taken on both arms for comparison. The difference between the two arms is generally 10 mm Hg or less.

The diagnosis of hypertension should be confirmed with measurements made on several days, although if severely elevated, treatment may be initiated after one reading. It’s often helpful to have a patient check their blood pressure in a setting besides the doctor’s office where they may be more relaxed.

Monitoring Your Blood Pressure at Home

Research shows home blood pressure monitoring can be vital to reducing a patient’s risk of stroke, heart attack, heart failure or kidney failure. In fact, internationally recognized organizations, such as The American Heart Association, recommend any patient with or at risk of hypertension should purchase a clinically validated home blood pressure monitor and regularly monitor their blood pressure at home. You can get an inflatable blood pressure cuff online or at any medical supply store to keep a closer eye on your progress.

People with high blood pressure who monitor at home show an improvement in medication compliance and are quicker to take action.

What Causes High Blood Pressure?

Many factors can contribute to developing high blood pressure. Some can be controlled, such as weight, eating too much salt, drinking too much alcohol, and lack of physical exercise. The exact role of stress is unclear, but is felt to be a factor as well.

Some factors that cannot be controlled are heredity (the genetic predisposition to having high blood pressure), older age, and race. In the U.S., African-Americans are at higher risk for hypertension. According to WebMD, this could be due to genetic reasons, such as a higher sensitivity to salt, or enviornmental reasons, like the stressors of discrimination and economic equality. There are secondary causes of hypertension, such as endocrine problems or kidney problems, but these are less common.

How Is Hypertension Treated? 

Lifestyle Modification

Changes in a person’s lifestyle can significantly lower blood pressure. Some people can lower pressure enough to where they do not need medications while with others the changes can reduce the amount of medications needed. 

Diet

For many, but not all people, reduction in sodium intake is very important. The American Heart Association suggests consuming no more than 1500 mg of salt daily for those with hypertension. It can be hard to measure exactly how much sodium you’re eating, but removing processed foods from your diet, checking sodium labels on food packaging, and going easy on the salt shaker can all help.

One-quarter teaspoon of salt has approximately 600 mg. According to Mayo Clinic, a specific diet to help lower blood pressure has been created in order to help people gain a greater understanding of what they’re putting into their bodies, called the Dietary Approaches to Stop Hypertension, or DASH diet. This diet emphasizes fruit, vegetables, low- and non-fat dairy products, lean meats, fish, beans, and nuts.

Exercise

Exercise can help lower blood pressure by training your heart to work stronger, and pump blood more easily throughout your arteries. Maintaining a healthy weight for one’s height will also reduce blood pressure.

Medication

All people with hypertension should be treated with some sort of lifestyle modification; however, many will still need medication. There are several types or classes of blood pressure medications that work in different ways. Some examples are diuretics (water pills), and vasodilators that relax the arterial wall. It’s common to use one or more medications from different classes.

Medications are also chosen according to other medical conditions that a patient may have. For example, a beta blocker may be used in a person with high blood pressure who has also had a heart attack. A person may be on one, two, three, or more different medications at any time to treat hypertension. It is important to take medications as prescribed as they are formulated to work for either 12 or 24 hours. Some people experience side effects from the medications, and it is important to work closely with health care providers to establish a regimen that is effective and easy for the patient to maintain. There are many generic medications available which are equivalent to brand-name formulations. 

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Article written by Merle Myerson, MD, EdD, FACC
Director, St. Luke’s and Roosevelt Hospitals Cardiovascular Disease Prevention Program Pre-Exercise Heart Screening Program...