Doctor’s Note: Handling your blood pressure
One of the bread and butter aspects of medicine is managing your blood pressure. This is a topic that frequently comes up and is one of the key vital signs we routinely obtain for a typical clinic visit. Why does it matter? What does it mean?
Let’s imagine you’re at your kitchen sink. You turn the water on, and you may notice that the water goes into the drain. This water creates pressure on the pipes, and the more water that goes in, the higher the pressure the water creates. This is your top number, and one in which your heart is beating, where the blood flow as your heart pumps creates pressure on the arteries.
Now you turn the water off. There’s no more pressure from the water onto the pipes. However, there is always some sort of baseline pressure on the pipes. This is your bottom number. This is why the top number is always higher than the bottom number — we can also certainly discuss why we use millimeters of mercury as our way of measuring the pressure, which makes for exciting dinner conversations, but is a topic for another day.
Since the bottom number is your baseline, this tends to be my focus for managing blood pressures. Generally, I like this number to be less than 90 but it does depend on your specific clinical situation.
The top number tends to fluctuate up and down and has to do with whatever makes your heart beat harder and/or faster (such as your food or drinks, stress levels, activity levels, medications, etc.). As a result, I tend to be fairly liberal when it comes to elevations (unless it’s emergent) because this is much more context dependent. A bit of stress isn’t always a bad thing — it is a good motivator, and makes you get up and going.
Let’s go back to your kitchen sink. If your pipes get clogged up or break, you’ll probably call the plumber. Conversely, if the pipes in your body get clogged up or break, you’ll probably go to the hospital.
This is why elevated blood pressures tend to be hidden diseases. You may feel your blood pressure rise when you get angry. Otherwise, people do not tend to notice their blood pressures in the same way as, say, an irregular heart beat or some sort of weird chest pain. It’s a long-term process, as well, and so what we do today will matter not only for today, but also 20 years from now. The key is making sure your pipes don’t break!
Daniel L. W. Hanley, MD, is a board-certified Family Medicine physician, trained in Chicago and based in Bokeelia, holding a special interest in managing chronic illnesses.