What does it mean when your diastolic pressure goes up

THURSDAY, July 18, 2019 (HealthDay News) -- When it comes to blood pressure readings, the "top" number seems to grab all the attention.

But a large, new study confirms that both numbers are, in fact, critical in determining the risk of heart attack and stroke.

Blood pressure measurements are given as a "top" and "bottom" number. The first reflects systolic blood pressure, the amount of pressure in the arteries as the heart contracts. The second reflects diastolic blood pressure, the pressure in the arteries between heart muscle contractions.

For years, systolic blood pressure has been seen as the one that really matters. That's based on studies -- including the famous Framingham Heart Study -- showing that high systolic blood pressure is a stronger predictor of heart disease and stroke.

At the same time, though, doctors measure both systolic and diastolic blood pressure, and treatment guidelines are based on both. So just how important is that diastolic number?

"The idea behind this new study was to address the confusion," said lead researcher Dr. Alexander Flint, an investigator with Kaiser Permanente Northern California's division of research.

Using medical records from 1.3 million patients, his team confirmed that, yes, high systolic blood pressure was a stronger risk factor for heart attack and stroke. But those risks also climbed in tandem with diastolic pressure; and people with normal systolic readings were still at risk if their diastolic pressure was high.

"There's been a common belief that systolic blood pressure is the only one that matters," Flint said. "But diastolic definitely matters."

He and his colleagues reported the findings in the July 18 issue of the New England Journal of Medicine.

The definition of high blood pressure has gotten a revamp in recent years. Guidelines issued in 2017 by the American College of Cardiology (ACC) and other heart groups lowered the  threshold for diagnosing the condition -- from the traditional 140/90 mm Hg to 130/80.

The fact that treatment guidelines include a diastolic pressure threshold implies that it's important. And indeed it is, said Dr. Karol Watson, a member of the ACC's prevention section and leadership council.

In fact, she said, doctors once thought that diastolic blood pressure was the more important one -- based on research at the time. Then came the studies showing that systolic pressure was generally a better predictor of people's risk of heart disease and stroke.

In addition, Watson said, high systolic blood pressure is more prevalent, because of natural changes in blood pressure as people age.

"As we get older, systolic blood pressure keeps marching up," she explained. Diastolic blood pressure, on the other hand, generally peaks when people are in their 40s to 60s -- and then it declines.

But it's clear, Watson said, that while systolic and diastolic blood pressure are different, they both deserve attention.

In the latest study, cardiovascular risks rose with each "unit increase" in systolic pressure above 140, by about 18% on average. Meanwhile, each increase in diastolic blood pressure above 90 was tied to a 6% increase in heart disease and stroke risk.

The researchers saw a similar pattern when they looked at blood pressure increases above the 130/80 threshold. That, Flint said, supports the 2017 guideline shift.

The findings are based on over 1.3 million patients in the Kaiser Permanente health system who had roughly 36.8 million blood pressure readings taken from 2007 through 2016. Over eight years, more than 44,000 patients had a heart attack or stroke.

According to Flint, it's the largest study of its kind to date.

The bottom line for patients, Watson said, is that they should care about both blood pressure numbers. In her experience, she noted, patients often point to the number that's in the normal range and say, "But look how good this is."

Flint agreed, saying that no one should "ignore" the diastolic number. "It's important not only in blood pressure treatment, but on the side of diagnosis, too," he said.

When you get your blood pressure numbers, there are two of them. The first, or “top” one, is your systolic blood pressure. The second, or “bottom,” one is diastolic blood pressure.

Knowing both is important and could save your life.

What Does the Systolic Blood Pressure Number Mean?

When your heart beats, it squeezes and pushes blood through your arteries to the rest of your body. This force creates pressure on those blood vessels, and that's your systolic blood pressure.

Here’s how to understand your systolic blood pressure number:

• Normal: Below 120
• Elevated: 120-129
• Stage 1 high blood pressure (also called hypertension): 130-139
• Stage 2 hypertension: 140 or more
• Hypertensive crisis: 180 or more. Call 911.

What Does the Diastolic Blood Pressure Number Mean?

The diastolic reading, or the bottom number, is the pressure in the arteries when the heart rests between beats. This is the time when the heart fills with blood and gets oxygen.

This is what your diastolic blood pressure number means:

• Normal: Lower than 80
• Stage 1 hypertension: 80-89
• Stage 2 hypertension: 90 or more
• Hypertensive crisis: 120 or more. Call 911.

Our chart below has more details.

Even if your diastolic number is normal (lower than 80), you can have elevated blood pressure if the systolic reading is 120-129.

Blood Pressure Ranges

If you have normal blood pressure, your blood pressure is less than 120/80. Stick with an active lifestyle and healthy diet to keep that going.

Is your blood pressure above the normal range, in either or both systolic and diastolic levels? Your doctor will want to have more than one blood pressure reading before diagnosing hypertension.

Treatments include lifestyle changes, and if that’s not enough, may also include medications.

Lifestyle changes include:

• Cutting back on sodium. Ask your doctor what your daily sodium limit should be. Read the Nutrition Facts label on food products.
• Getting more exercise. Studies show benefits with 3-4 sessions per week, each lasting 40 minutes, of aerobic exercise (the kind that makes your heart beat faster).
• Losing weight, if you’re overweight. You can expect to shave about 1 point off your blood pressure numbers for each pound lost.
• Eating a healthy diet. The DASH diet is designed to improve blood pressure. DASH stands for Dietary Approaches to Stop Hypertension. It favors vegetables, fruits, whole grains, low-fat dairy, poultry, fish, and chicken.
• Limiting alcohol to no more than one drink a day for women or two for men.

If you also need medication to lower your blood pressure, there are several types:

• Diuretics
• ACE inhibitors
• Alpha blockers
• Angiotensin II receptor blockers (ARBs)
• Beta-blockers
• Calcium channel blockers
• Central agonists
• Vasodilators
• Combination medications

If you need medication, your doctor will consider which type is best for you. (They’ll also recommend lifestyle habits that help lower blood pressure.) Deciding whether you need medication is often done on a case-by-case basis, depending on what else is going on with your health and on your preferences.

If you have:

• Elevated blood pressure: Your systolic pressure is 120-129 and your diastolic pressure is less than 80. Lifestyle changes and monitoring your blood pressure may be all you need at this point. Your doctor will let you know.
• Stage 1 hypertension: Systolic 130 to 139 or diastolic 80 to 89. Your doctor will recommend lifestyle changes and will consider whether you also need medication.
• Stage 2 hypertension: Systolic at least 140 or diastolic at least 90. Your doctor will recommend lifestyle changes and should also consider starting you on medication to lower your blood pressure.
• Hypertensive crisis: Your blood pressure is 180/120 or higher. You may or may not also have symptoms such as chest pain, shortness of breath, numbness/weakness, and trouble with vision or with speaking. This is an emergency. Call 911.

One reading may not be enough to diagnose high blood pressure. Your doctor may want you to have several blood pressure readings over time, to check if it’s consistently too high.

How Blood Pressure Is Measured

A doctor or nurse will measure your blood pressure with a small gauge attached to an inflatable cuff. It's simple and painless.

The person taking your blood pressure wraps the cuff around your upper arm. Some cuffs go around the forearm or wrist, but often they aren't as accurate.

Your doctor or nurse will use a stethoscope to listen to the blood moving through your artery.

They’ll inflate the cuff to a pressure higher than your systolic blood pressure, and it will tighten around your arm. Then they’ll release it. As the cuff deflates, the first sound they hear through the stethoscope is the systolic blood pressure. It sounds like a whooshing noise. The point where this noise goes away marks the diastolic blood pressure.

In a blood pressure reading, the systolic number always comes first, and then the diastolic number. For example, your numbers may be "120 over 80" or written as 120/80.

When to Check Blood Pressure

• If your blood pressure is normal (less than 120/80), get it checked every year, or more often as your doctor suggests.
• If your blood pressure is elevated -- a systolic blood pressure between 120 and 129 or diastolic blood pressure of less than 80 -- your doctor will probably want to check it every 3-6 months. They will probably recommend lifestyle changes like more exercise and a better diet.
• If you have stage 1 hypertension -- 130-139 over 89-90 -- the doctor might suggest lifestyle changes and see you again in 3-6 months. Or they could tell you to make the changes and give you medication, then recheck your condition in a month. It depends on what other health conditions or risk factors you have.
• If you have stage 2 hypertension -- 140/90 or higher -- you’ll likely get medication. You'll also need to make lifestyle changes and see the doctor again in a month.

Checking Blood Pressure at Home

Keeping track of blood pressure at home is important for many people, especially if you have high blood pressure. This helps you and your doctor find out if your treatment is working.

Your doctor may also suggest that you check your pressure at home if they think you may have "white coat hypertension." It's a real condition. The stress of being in a doctor's office raises your blood pressure, but when you're home, it's normal.

Ask your doctor to recommend an easy-to-use home blood pressure monitor. Make sure the cuff fits properly. If your arm is too big for the cuff, the reading may be higher than your blood pressure really is. Ask your doctor for a larger cuff or make sure you buy a home monitor with a cuff that fits you.

You also can use a wrist blood pressure monitor, but they often aren't as accurate. Follow the directions that come with the device to make sure you are using it correctly.

No matter which type of blood pressure monitor you have, it's a good idea to take it to your doctor's office. You can compare its reading to the numbers your doctor gets. Avoid caffeine, cigarettes, and exercise for at least 30 minutes before the test.

When you take your blood pressure at home, sit up straight in a chair and put both feet on the floor. Ask your doctor or nurse to show you the right way to position your arm so you get accurate readings.

Check it at the same time of day so the readings are consistent. Then, take several readings about 1 minute apart. Be sure to write down the results.

Take the blood pressure journal to your doctor's office so you can talk about any changes in your numbers. Your doctor will decide whether you need medications in addition to lifestyle changes.

Even if your blood pressure is high, you probably won't have symptoms. That's why it's often called the "silent killer." The first symptom of untreated high blood pressure may be a heart attack, stroke, or kidney damage.

Preventing High Blood Pressure

To keep your blood pressure in the normal range, your daily habits are key. These things help:

Don’t smoke. Among the many health problems that smoking causes, it raises your blood pressure.

Make physical activity a habit. Most experts recommend at least 30 minutes of moderate-intensity physical activity (like biking or brisk walking) five or more times a week. Or you could do a harder activity for a shorter period of time per session.

Eat right. Read food labels to see how much sodium is in a serving. Check with your doctor to find out what your daily limit should be. Include a lot of vegetables and fruits, along with whatever else you choose to put on your plate.

Stick to a healthy weight. Extra pounds raise your blood pressure. If you’re not sure what a healthy weight would be for you, ask your doctor.

Get enough sleep. For most adults, that’s 7-8 hours of sleep per night, on a regular basis.

If you drink alcohol, limit it to no more than one drink a day if you’re a woman and up to two drinks a day if you’re a man.