March 4, 2011

Dear Mayo Clinic:

Lately when I have my blood pressure checked it is slightly higher than it has been over the years. How can I keep my blood pressure in a healthy range? What are ideal levels?

Answer:

Your situation is normal. Quite commonly, blood pressure rises with age. For example, even if your blood pressure is within the normal range when you're 40 years old, there's a 50 percent chance it will be higher than normal when you reach 65.

Blood pressure is a measure of the pressure in your arteries as your heart pumps. Testing your blood pressure is an important way for your doctor to monitor your general health. A high blood pressure reading may signal that you're at increased risk for a heart attack or stroke.

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

Generally, normal blood pressure is less than 140/90 when it's taken in a doctor's office. If you monitor your blood pressure at home, normal is a little lower at 135/85. Visiting a doctor may be a bit stressful for some people, and stress can sometimes raise blood pressure. The higher normal level at the doctor's office takes that into account. People at the lowest risk of stroke and heart attack have blood pressure readings less than 120/80. These are the normal levels used for healthy people. The target for patients younger than 80 years old who are taking medication to regulate their blood pressure is less than 140/90.

For someone in your situation who has noticed a slight rise in blood pressure, you can take self-care steps that may help keep your blood pressure within the normal range.

First, watch what you eat and drink. Limit the amount of salt in your diet. Shoot for no more than 2,000 milligrams of sodium per day. You should carefully read food labels and recognize that "high salt foods" are those with more than 250 milligrams of sodium per serving. Try and choose foods you like with less sodium per serving than that. Focus on eating healthy foods, including lots of fruits, vegetables and whole grains. Drink no more than one alcoholic beverage a day, and keep your daily caffeine intake to less than four units. (One cup of coffee or one can of caffeinated soda is one unit.)

Second, maintain a healthy weight. If you're overweight, losing just 5 to 10 pounds can have a positive effect on your blood pressure. Regular physical activity can also help lower your blood pressure, as well as keep your weight under control. Strive for 45 to 60 minutes of daily aerobic exercise, such as biking, swimming or brisk walking. The time you spend exercising is more important than the intensity.

Third, if you smoke, quit. Avoid secondhand smoke as much as possible. The nicotine in cigarette smoke makes your heart work harder by narrowing your blood vessels and increasing your heart rate and blood pressure. Carbon monoxide in cigarette smoke replaces some of the oxygen in your blood. This increases your blood pressure by forcing your heart to work harder to supply your body with the oxygen it needs.

Finally, if you're concerned about your blood pressure, avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium. NSAIDs may cause you to retain sodium, creating kidney problems and raising your blood pressure.

Continue to have your blood pressure monitored regularly, at least once a year. If your blood pressure is persistently elevated despite making lifestyle changes, talk to your doctor. Additional measures, which may include medications that lower blood pressure, may be necessary to keep your blood pressure at a healthy level.

— John Graves, M.D., Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.

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