THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 517.5 Guest: Louis Grenzer, M.D. Topic: Blood Pressure Numbers - One Part Host: Richard Roeder Producer: Ed Graham

NEMA: This is a conversation about the numbers that make up your blood pressure and what they mean. My guest is cardiologist Dr. Louis Grenzer from Baltimore, Maryland.

NEMA: Dr. Grenzer, one of the most common ways that blood pressure is expressed is two numbers, a typical healthy number being something like 120 over 70. In a past program you explained what the bottom number and the top number mean as far as what the heart is doing but one thing I would like you to talk about a little bit in this program is the significance of those numbers because they do tend to indicate different things about a person's circulatory health. Would you talk about that a little bit.

GRENZER: Yes I will. We basically measure a systolic blood pressure which is the upper number and a diastolic blood pressure which is the lower number. Just to review, the upper number is when your heart is actually contracting and the lower number is the pressure when your heart is relaxing and you know, the thinking about this has changed over the years. If you go back a few years to when I first started practicing, we paid much more attention to that diastolic number and it was felt that the high systolic or upper number blood pressure was not that significant. Studies certainly showed that people with a high diastolic blood pressure were much more at risk to develop heart disease, strokes, kidney problems and so it became clear that we need to treat that hypertension even if the patient feels well to prevent the complications. Back then, back a few years, not as much attention was paid to the systolic pressure because it was not felt that that was as important as far as producing side effects. More recent studies have shown that we can't ignore the systolic pressure because people with a high systolic pressure are also at increased risk to develop complications. So the trend over the last few years is to also try and bring down the systolic pressure. Sometimes that's a little more difficult. You have to do it sort of gradually, particularly in older patients or you might find that you are producing a lot of symptoms and side effects so whereas we recognize that we have to treat both the upper number and the lower number, there are little differences in how aggressively we can treat it and how quickly we can bring it down because the medications and the actual bringing down of the blood pressure sometimes will produce side effects and symptoms in the patient.

NEMA: As we speak, what do you consider - and I realize this gets negotiated back and forth to some small degree anyway - what is considered to be for an average healthy person healthy blood pressure? What is the average top and bottom number that you would say that's a heart healthy person?

GRENZER: The cut off that is generally accepted is 140 for the upper number and 90 for the lower number but even then, lots of cardiologists wouldn't be that happy if your diastolic number was 88 or 89 or 87. 120 over 80 is pretty much considered the average normal blood pressure so when we start getting up to once again anything over 140 for the upper number, anything at 90 or above for the lower number, this is clearly elevated.