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Take a look at one of the biggest risk factors for heart attack and stroke: elevated blood pressure

By: Dr. Brian Byrd

What is Good Blood Pressure?

Hypertension remains the biggest risk factor for stroke (see previous blog on stroke) and the second leading cause of heart attacks. When you visit our clinic, your physician’s staff will check your blood pressure using an arm cuff.

Blood pressure is created in our bodies by the pumping of the left side of our hearts. Every beat brings about a big squeeze from our heart muscle that contracts and relaxes 50-120 times a minute our entire lives.

When the heart muscle squeezes, a bolus of blood is pushed into our arteries and that movement creates pressure in the “system.” The walls of the arteries are muscular and stretchy so when the heart squeezes pressure into them they expand just a little to accommodate the extra blood.

That expansion minimizes the pressure elevation. Interestingly, when we get older, our arteries stiffen and we aren’t able to diminish the intra-arterial pressure.

We track two “types” of pressure. Systolic (the top number) is the peak pressure right at the moment when the heart is squeezing blood into our arteries. The pressure in our system when the heart is relaxed is called the diastolic pressure and is represented as the lower number on a blood pressure reading.

A healthy systolic pressure for an adult is between 105 and 139. Our diastolic pressure should range between 65 and 89.

But remember, as your physicians, we don’t treat numbers. We treat you. The numbers guide our treatment to keep you out of the hospital.

Some blood pressure is good! We can’t get blood up to our heads without some pressure pushing against gravity, for example. And when we exert ourselves physically, our arterial system expands to allow more oxygen delivery to our muscles. The pressure in the system allows our blood to disseminate where it is needed.

Blood Pressure Problems

Too little pressure is a big problem. It happens when we lose too much blood, become dehydrated, injure the heart muscle in a heart attack, or have a blood infection. When our blood pressure drops we feel light headed and we can pass out. Not good! If you are feeling lightheaded, be sure to tell your doctor.

Too much blood pressure - over time - causes heart attacks and strokes.

Imagine your heart muscle pumping against a high pressure head. It’s like pedaling a bicycle uphill when the tires are nearly flat. Eventually, the heart muscle fatigues.

If there is some cholesterol buildup in the arteries that take blood to the heart muscle, a strained heart muscle cell can die from lack of oxygen. That is what happens in a heart attack.

Hypertension, over a period of months and years, causes cholesterol plaques to build up in the arteries in our brain. If a little bit of that plaque breaks off it will float downstream and lodge itself in a smaller artery.

Whammo. That artery is clogged and the brain cells that it serves quickly starve from a lack of oxygen, and die. We call that scenario a stroke.

That is why your doctor will regularly check your blood pressure. If we find two or more readings of elevated pressure, we take it seriously and talk to you about treatment.


The main cause of hypertension is age. We humans naturally develop elevated blood pressure more and more the longer we live.

Poor diet, especially one high in salt is a contributor. So is being overweight, and having diabetes or chronic kidney disease.

Other, less common causes are the use of some medications such as decongestants, painkillers like ibuprofen, and steroids such as prednisone. Many of these medications are over the counter so be sure to check before you take them.


Lifestyle changes are the first part of treatment. Avoidance of foods high in trans-fat and salt helps with elevated blood pressure. So does weight loss.

Cardiac exercise and resistance (weights) training also relieve hypertension. We recommended 30 minutes of moderate exercise daily such as riding a stationary bike or walking briskly with a target heart rate of 200 minus your age. The exercise keeps the arterial walls healthy and stretchy.

Don’t forget that those stretchy arterial walls are one of our bodies main ways to moderate our blood pressure. People with stiff arteries often have a high “pulse pressure,” i.e. the difference between their systolic and diastolic pressures increases.

Medications are helpful for controlling elevated blood pressure. Your physician may prescribe one or more meds to help lower your pressure to a healthy level. In fact, most people with hypertension require two medications to get to target.

Most of the hypertension medications we prescribe for our patients have been around for more than a decade and come in generic formulations. They are inexpensive, safe, and are an easy way to prevent heart attack and stroke in our patients.

There are a number of classifications of blood pressure medications: diuretics, beta-blockers, ARB’s, ACE’s, calcium-channel blockers and vasodilators. You and your physician will pick the right one or combination for you.

We target less than 140/90 for your blood pressure. Multiple well-done studies have proven that the 140/90 is a helpful cutoff.

If you have diabetes or proven coronary artery blockages, your physician may lower your systolic pressure to less than 130 or even less than 120. But we must use caution when driving down the pressure because we don’t want to “bottom out” your pressure and cause you to fall.

You can monitor your blood pressure at home by purchasing a quality cuff. Omron makes a nice upper arm home machine. Stay away from wrist cuffs which aren’t as reliable.

Your physician may choose to monitor your blood pressure remotely by mailing you a machine that is digitally connected to an online portal. We follow along with you and reach out to you if we notice a harmful trend in your blood pressure readings. Medicare calls this program Remote Patient Monitoring and is willing to pay for it since it is proven to keep patients out of the ER and hospital.


Hypertension is a quiet but deadly disease. A majority of the time you can’t feel its effects on you until it is too late. But by working with your physician, you can lower your blood pressure to a healthy range and easily remove one of the strongest risk factors for heart attack, disabling stroke, and sudden cardiac arrest.

Brian Byrd, MD

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