What do your blood pressure numbers mean?The only way to know if you have high blood pressure, also known as hypertension, is to have your blood pressure tested. Understanding your results is key to controlling high blood pressure.
Blood pressure numbers of less than 120/80 mm Hg (millimeters of mercury) are considered within the normal range. If your results fall into this category, stick with heart-healthy habits like following a balanced diet and getting regular exercise.
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Elevated blood pressure is when readings consistently range from 120-129 systolic and less than 80 mm Hg diastolic. People with elevated blood pressure are likely to develop high blood pressure unless steps are taken to control the condition.
Hypertension Stage 1 is when blood pressure consistently ranges from 130 to 139 systolic or 80 to 89 mm Hg diastolic. At this stage of high blood pressure, health care professionals are likely to prescribe lifestyle changes and may consider adding blood pressure medication based on your risk of atherosclerotic cardiovascular disease, or ASCVD, such as heart attack or stroke.
Hypertension Stage 2 is when blood pressure consistently is 140/90 mm Hg or higher. At this stage of high blood pressure, health care professionals are likely to prescribe a combination of blood pressure medications and lifestyle changes.
This stage of high blood pressure requires medical attention. If your blood pressure readings suddenly exceed 180/120 mm Hg, wait five minutes and then test your blood pressure again. If your readings are still unusually high, contact your health care professional immediately. You could be experiencing a hypertensive crisis.
If your blood pressure is higher than 180/120 mm Hg or you are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision or difficulty speaking, do not wait to see if your pressure comes down on its own. Call 911.
Typically, more attention is given to systolic blood pressure (the first number) as a major risk factor for cardiovascular disease for people over 50. In most people, systolic blood pressure rises steadily with age due to the increasing stiffness of large arteries, long-term buildup of plaque and an increased incidence of cardiac and vascular disease.
Objective: To investigate the effect of an artificial intelligence smartphone coaching app to promote home monitoring and hypertension-related behaviors on systolic blood pressure level compared with a blood pressure tracking app.
Interventions: Intervention group participants received a smartphone coaching app to promote home monitoring and behavioral changes associated with hypertension self-management plus a home blood pressure monitor. Control participants received a blood pressure tracking app plus a home blood pressure monitor.
Main outcomes and measures: The primary study outcome was systolic blood pressure at 6 months. Secondary outcomes included self-reported antihypertensive medication adherence, home monitoring and self-management practices, measures of self-efficacy associated with blood pressure, weight, and self-reported health behaviors.
Results: There were 333 participants randomized, and 297 completed the follow-up assessment. Among the participants who completed the study, the mean (SD) age was 58.9 (12.8) years, 182 (61.3%) were women, and 103 (34.7%) were black. Baseline mean (SD) systolic blood pressure was 140.6 (12.2) mm Hg among intervention participants and 141.8 (13.4) mm Hg among control participants. After 6 months, the corresponding mean (SD) systolic blood pressures were 132.3 (15.0) mm Hg and 135.0 (13.9) mm Hg, with a between-group adjusted difference of -2.0 mm Hg (95% CI, -4.9 mm Hg to 0.8 mm Hg; P = .16). At 6 months, self-confidence in controlling blood pressure was greater in the intervention group (0.36 point on a 5-point scale; 95% CI, 0.18 point to 0.54 point; P < .001). There were no significant differences between the 2 groups in other secondary outcomes. The adjusted difference in self-reported physical activity was 26.7 minutes per week (95% CI, -5.4 minutes per week to 58.8 minutes per week; P = .10). Subgroup analysis raised the possibility that intervention effects differed by age.
Conclusions and relevance: Among individuals with uncontrolled hypertension, those randomized to a smartphone coaching app plus home monitor had similar systolic blood pressure compared with those who received a blood pressure tracking app plus home monitor. Given the direction of the difference in systolic blood pressure between groups and the possibility for differences in treatment effects across subgroups, future studies are warranted.
The American Heart Association (AHA) defines blood pressure as a force that pushes blood through a network of arteries, veins and capillaries. The blood pressure reading is the result of two forces: the systolic pressure occurs as blood pumps out of the heart and into the arteries; diastolic pressure is created as the heart rests between heart beats (American Heart Association, 2018). Elevated blood pressure, or hypertension, leads to harm by causing tiny tears in the interior lining (intima) of the arteries and coronary vessels, stimulating a local immune response in the endothelial cells within the atrial walls. In these regions, the arterial intima retains apolipoprotein B, which attracts lipid-rich macrophages (foam cells). These preatherotic lesions develop into atherosclerotic plaques which become increasingly fibrotic and can form fissures, hematomas, thrombi, and calcifications (Swirski and Nahrendorf, 2013). The end result is stiff, thickened arteries that narrow the flow of blood to organs and limbs, which both increases pressure on target organs and limits oxygenation of them.
Hypertension is the second leading cause of kidney failure. The nephrons in the kidneys are supplied with a dense network of blood vessels and high volumes of blood flow through them. Over time uncontrolled high blood pressure can cause arteries around the kidneys to narrow, weaken or harden.
These damaged arteries are not able to deliver enough blood to the kidney tissue. Kidney damage and uncontrolled high blood pressure affect aldosterone production contributing to a negative spiral of increasing blood pressure and eventual kidney failure.
Manual BP monitoring in the clinical office gives point-in-time BP readings. The most traditional method of measurement is the auscultatory method, in which a trained observer uses a stethoscope to detect Korotkoff sounds which are made by the turbulent flow of blood through the brachial artery past the restricted area created by the inflated cuff. The readings are made using a mercury or aneroid sphygmomanometer. Sources of observer error and bias in the auscultatory method include differences in auditory acuity and terminal digit rounding (Piper et al., 2014). Oscillometric sphygmomanometers use a pressure transducer to assess the oscillations of pressure in a cuff during gradual deflation. The point of maximum oscillation corresponds to the mean intra-arterial pressure. Systolic and diastolic measurements are then calculated based on an empirically derived algorithm (Piper et al., 2014).
The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for high BP in adults aged 18 years or older and recommends obtaining measurements outside of the clinical setting (either ABPM or home BP monitoring) for diagnostic confirmation of high BP before starting treatment (Sui, 2015). The USPSTF specifically states that "In addition to office blood pressure measurement, ABPM and HBPM may be used to confirm a diagnosis of hypertension after initial screening" (US Preventive Services Task Force, 2019).
Our review and analysis of the evidence on the clinical utility of ABPM in patients with office-based elevated (white coat) blood pressure, and in patients being treated for hypertension who are suspected as having masked hypertension, is guided by the following questions:
While CMS did not request an external technology assessment (TA) as part of this reconsideration, a structured literature review and meta-analysis that focused on the effects of blood pressure monitoring was conducted by the US Preventive Services Task Force (USPSTF) and published by the Agency for Healthcare Research and Quality (AHRQ) in 2014. It was published in condensed form in the Annals of Internal Medicine in 2015.
Piper MA, Evans CV, Burda BU, Margolis KL, O'Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015 Feb 3;162 (3):192-204. doi: 10.7326/M14-1539. PubMed PMID: 25531400.
The authors performed a technology assessment that included a systematic literature review and meta- analysis to support the USPSTF in updating its recommendation on screening for high blood pressure (BP) in nonpregnant individuals. The USPSTF report focused on screening for high BP. The USPSTF report evaluated the benefit of office based BP measurement and out-of-office measurement with an emphasis on ABPM.
The authors conducted a meta-analysis to evaluate the best predictors of cardiovascular events by BP measurement method (ABPM, OBPM, and other out-of-office measurements). Where reported, all ABPM devices were oscillometric, and typically took measurements every 15 to 30 minutes during the day and every 30 to 60 minutes at night. Outcomes for 24-hour, daytime, and nighttime monitoring cycles were reported in 8, 10, and 9 studies, respectively. Results did not vary by geographic region or population baseline characteristics. Unadjusted hazard ratios (HRs) for systolic OPBM were not consistently statistically significant, ranging from 1.07 to 1.29 for stroke and 1.06 to 1.32 for CV events or mortality (Figure 1). This pattern of results for OBPM was similar across all ABPM versus OBPM comparisons and outcomes. 2351a5e196
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