How do you know when you really need blood pressure medications?

DEAR DR. ROACH »

I’m a 71-year-old female who is basically in good health. I am active and still working. I usually walk 3 miles per day, five days per week, and try to stay limber by doing strength training and stretching to enhance my health. I eat healthy with low salt and hardly any caffeine.

How do you know when you really need blood pressure medicine? I have received conflicting advice. For example, I have been told that blood pressure is a cycle in that it is lowest when sleeping, rises in the morning and continues to rise during the day and then starts to go down at night; however, I’ve been told it should be kept to 120/80.

— D.C.S.

DEAR READER » Variations in blood pressure send many people to see their medical doctor, and we know a great deal about its complications and treatment.

More information about a person’s blood pressure is better: A single reading a few times a year at a doctor’s office is not the optimal amount of data. A high-quality home blood pressure cuff is a great way to get additional information. The more readings, the better.

Blood pressure does go up and down normally, and so it is the average blood pressure that you want to know. Blood pressure at night tends to be lower than during the day, so there are standards for average daytime (130/80) and nighttime (110/65).

A 24-hour ambulatory blood pressure monitor has become the definitive method of measuring blood pressure, and is a better predictor of the types of events we are trying to prevent (heart attack, stroke) than office blood pressures.

Blood pressure can go up if a person is anxious or nervous; this is called white-coat or reactive hypertension if in a doctor’s office. While an occasional reading of 135 or 140 is not a problem, an average systolic over 130 is higher than optimal. Treatment even of that low number does reduce the risk of heart attack and stroke, at least in people who had additional risks for heart disease.

You and your doctor should check your average reading to decide whether treatment will be helpful.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.