Understanding Highs and Lows of Your Blood Pressure

How low your blood pressure should go

By: Steven Nissen, MD

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Here at Cleveland Clinic, patients frequently ask us cardiologists this question: “Is my blood pressure too high, or is it too low?” We’re always happy to answer, because it’s important for you as a patient to understand your blood pressure. Blood pressure is the measurement of the pressure or force inside your blood vessels or arteries with each beat of the heart. When that pressure is above normal, we say your blood pressure is high. Ideal blood pressure should be 120/80 and it enters the “high” range at 140/90.

Dash for lower blood pressure

Good news: We can lower blood pressure in some people by five or ten points when they eat a more heart-healthy diet, like the DASH diet. DASH stands for “Dietary Approaches to Stop Hypertension” and this eating plan places a major nutritional focus on plants, fruits and vegetables, nuts, low-fat and non-fat dairy, lean meats, fish, poultry, mostly whole grains, and heart-healthy fats.  It tastes great, too. In addition, other lifestyle changes like increasing exercise and losing weight also have a big impact on lowering high blood pressure.



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Understand low numbers and symptoms

Many cardiologists believe that no specific number is really “too low,” if patients don’t exhibit symptoms. It’s true that we hear more about high blood pressure “problems” than low, so I want to talk about numbers that fall below normal, especially when we are treating for high blood pressure. Maybe you’re taking blood pressure medication, and your top number is 110 or even 100. Don’t be alarmed, but you should talk to your doctor if you have concerns like dizziness when you stand up, or if your top or systolic number falls below 100.

Know how low numbers help

We know now that defining blood pressure is not the same for everyone and that blood pressure goals with medication treatment can be controversial. For example, we know that some patients who have congestive heart failure may consistently have lower numbers—congestive heart failure is a chronic long-term disease managed with medication, because the heart doesn’t function or pump as well as it should.

When the heart doesn’t pump out blood that it pumps in, it can cause excess fluid to accumulate in the lungs and other bodily tissues. We find that in many cases, these unusually low numbers aren’t harmful because they allow the heart to pump more effectively, plus they lighten the heart’s workload—all good.  While blood pressure control may be looser in the elderly, a higher number such as 150/90 may be the goal to prevent dizziness and falls seen with lower numbers. These are not certain recommendations and should be individualized.

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Tips to control blood pressure

Your blood pressure numbers matter. Here are three tips that will help you get your blood pressure in control:

  1. Ask your doctor what the right blood pressure is for you
  2. Check your blood pressure at home. Keep a chart and bring it to your doctor’s visits. You should measure your blood pressure sitting after a period of quiet the same time every day – morning and evening.
  3. Make necessary lifestyle changes to help lower your blood pressure. DASH diet, exercise and get to your healthy weight.

Ask for help to control your blood pressure for a lifetime. You can make a real difference.

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