Ralph L. Sacco, MD, FAAN, responds:
A healthy blood pressure is crucial to reducing the risk of stroke and other cardiovascular diseases. The 2017 guideline from the American Heart Association and the American College of Cardiology says a normal blood pressure reading is anything lower than 130 over 80. How quickly it should be brought down depends on how high it is and how long it's been high.
Blood pressure is made up of two forces: systolic pressure, which pumps blood out of the heart and into the blood vessels, and diastolic pressure, which is created when the heart rests between beats. High blood pressure, also known as hypertension, occurs when the force of the blood pushing against the walls of the blood vessels is consistently too high.
Blood pressure is measured as two numbers. The higher or top number reflects systolic pressure (for example, 130) and the lower or bottom number represents diastolic pressure (for example, 80). If blood pressure remains high, it can damage the tissue inside arteries, leaving space for plaque to build up and narrow the insides of the arteries, which raises blood pressure even more and can lead to heart disease, heart attacks, and stroke.
For some people, losing weight, eating healthier foods, and exercising can be enough to lower blood pressure. Others may need to make lifestyle changes and take medication.
Doctors decide on treatment based on blood pressure readings, risk factors for high blood pressure, and coexisting health problems. For example, patients who have an elevated risk of stroke or cardiovascular disease because of diabetes, high cholesterol levels, or a heart condition may be prescribed medication right away.
Once lifestyle modifications and medication bring blood pressure down to normal levels, patients may have to take medication and maintain their new healthy habits indefinitely. It's important to take medication as directed and talk to your doctor before adjusting or stopping the dose.
Doctors may increase the dose or add drugs, depending on the baseline blood pressure and how it responds to treatment. Doctors also may ask patients to buy a blood pressure cuff for at-home use and to call in their readings at regular intervals to make sure the condition is under control. Patients will be instructed on how and when to measure blood pressure—while sitting and more than 30 minutes after drinking coffee, for example.
The 10 classes of medications to treat high blood pressure include diuretics, which help eliminate excess water and sodium from the body (less fluid flowing through the veins and arteries reduces pressure on blood vessel walls), and beta blockers, which block the effects of epinephrine, a hormone also called adrenaline that can increase the force and speed of the heartbeat. Beta blockers help the heart beat more slowly and with less force.
Certain factors that increase the risk of high blood pressure can't be changed, such as family history, age (blood pressure often increases with age), sex (until age 64, more men develop high blood pressure; after age 65, more women develop it), and race (African Americans have higher rates of high blood pressure than whites). People can help keep their blood pressure in check by quitting or never smoking, exercising, limiting sodium, maintaining a healthy weight, managing stress, and preventing or treating high cholesterol, sleep apnea, or diabetes.
To lower your risk of high blood pressure, talk to your doctor or a nutritionist about changing your diet to include more whole foods such as fruits and vegetables and fewer processed foods and less sodium. Maintain a healthy weight, get regular exercise (the American Medical Association guidelines advise 30 minutes of moderate exercise on most days of the week or three 10-minute sessions a day), limit alcohol consumption, quit smoking or don't start, and incorporate stress-reducing activities such as meditation.