Blood Pressure

What it is

Arterial blood pressure recorded as systolic / diastolic (mmHg). Standard clinical measurement is by sphygmomanometer at rest after >5 minutes seated; home and 24-hour ambulatory measurements give better long-term estimates than single office readings.

Categories (US 2017 / European guidelines)

• Normal: <120/80 mmHg.
• Elevated: 120–129 / <80.
• Stage 1 hypertension: 130–139 / 80–89.
• Stage 2 hypertension: ≥140/90.

European guidelines retain ≥140/90 as the hypertension threshold while acknowledging benefit of lower targets in many adults.

Why it matters

SPRINT showed that intensive systolic targeting (<120) versus standard (<140) in higher-risk adults >50 reduced cardiovascular events by ~25% and all-cause mortality by ~27%. STEP (China) showed similar benefit in older adults. The downside is more adverse effects (syncope, acute kidney injury, electrolyte disturbance) and lower BP targets are not for everyone.

What lowers it

• Weight loss.
• Sodium reduction (more impact in salt-sensitive individuals).
• DASH or Mediterranean dietary patterns.
• Exercise.
• Reduced alcohol.
• Pharmacology: ACE inhibitors / ARBs, calcium-channel blockers, thiazide-like diuretics, beta-blockers, mineralocorticoid antagonists.

Measurement quality matters

Single-office BP often overestimates true ambulatory BP (“white-coat effect”) or underestimates it (“masked hypertension”). For meaningful decisions, get a validated home cuff and measure consistently.

Related entries

Cardiovascular disease, SPRINT trial, Mediterranean diet.