Blood pressure is one of the most important vital signs we check — and one of the most misunderstood. I see patients every week who can recite their numbers but have no idea what they mean or why they matter.
Let me change that.
What the Two Numbers Mean
Blood pressure is measured in two values, written as a fraction: systolic over diastolic (for example, 118/76).
Systolic pressure (the top number) is the pressure in your arteries when your heart contracts and pumps blood. Think of it as the peak pressure.
Diastolic pressure (the bottom number) is the pressure when your heart relaxes between beats. Think of it as the baseline pressure your arteries experience all the time.
Both numbers matter. Isolated systolic hypertension (elevated top number, normal bottom) is the most common pattern in older adults and carries significant cardiovascular risk.
What Do the Categories Mean?
| Category | Systolic | | Diastolic | |---|---|---|---| | Normal | Less than 120 | and | Less than 80 | | Elevated | 120-129 | and | Less than 80 | | Stage 1 Hypertension | 130-139 | or | 80-89 | | Stage 2 Hypertension | 140+ | or | 90+ | | Hypertensive Crisis | Higher than 180 | and/or | Higher than 120 |
These categories come from the 2017 AHA/ACC guidelines, which lowered the threshold for hypertension from 140/90 to 130/80.
Why Hypertension Is Called the "Silent Killer"
High blood pressure almost never causes symptoms until it causes damage. You don't feel your arteries stiffening. You don't feel increased pressure in your vessels. You feel fine — until you have a heart attack, stroke, or kidney failure.
This is why regular monitoring matters so much. By the time hypertension causes symptoms, it's usually caused damage.
What Causes High Blood Pressure?
In about 90% of cases, hypertension is "primary" or "essential" — meaning there's no single identifiable cause, but risk factors include:
- Family history
- Age (arteries stiffen as we get older)
- Obesity or overweight
- High sodium diet
- Physical inactivity
- Excessive alcohol
- Chronic stress
- Poor sleep / sleep apnea
In 10% of cases, hypertension is "secondary" to an identifiable cause — kidney disease, thyroid dysfunction, certain medications (including NSAIDs and decongestants), or sleep apnea. We screen for secondary causes, especially in younger patients.
What We Do About It at ParikhHealth
Lifestyle first. The DASH diet, regular aerobic exercise (150 minutes per week), weight loss, sodium reduction, and alcohol moderation can lower systolic blood pressure by 5-20 mmHg. For Stage 1 hypertension, lifestyle changes alone can often normalize blood pressure without medication.
When we add medication. For Stage 2 hypertension, persistent Stage 1 despite lifestyle changes, or if you have other cardiovascular risk factors (diabetes, kidney disease, prior heart attack), we add medication. The goal is to get your blood pressure below 130/80.
Home monitoring. I encourage all my hypertensive patients to monitor at home with a validated cuff (arm cuff, not wrist). Take readings at the same time each day, in both arms initially, and bring the log to your visits.
Monitoring and follow-up. Once we start treatment, we see you back in 4-6 weeks to check response and adjust as needed.
If you haven't had your blood pressure checked recently — or if you have a home reading you're concerned about — call us at 408-266-3100 or book an appointment online.