Blood pressure normally fluctuates

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.

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. I also read that as you get older it is natural and OK for the systolic to be 135. After

breakfast, many times I have pressure ranging from 104/65 to 134/72.

D.C.S.

Answer: Variations in blood pressure send many people to see their medical doctor, and we know a great deal about its complications and treatment. It is somewhat surprising, then, that there remains uncertainty about deciding who needs treatment.

A single reading a few times a year at a doctor’s office is not the optimal amount of data. A highquality home blood pressure cuff is a great way to get additional information.

The more readings, the better the picture.

Blood pressure does go up and down normally, and so it is the average blood pressure that you want to know. As you correctly said, 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. In absence of a 24hour blood pressure monitor, getting many readings throughout the day is likely to be a better guide to when treatment is necessary than just the 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 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.