New Advisory On Systolic Blood Pressure

Perhaps, like so many Americans, you've been told that your diastolic blood pressure (the bottom number) counts more in determining your health risk from high blood pressure. This has, in fact, been the prevailing wisdom, up until two years ago when the National Heart, Lung, and Blood Institute (NHLBI) issued an advisory to physicians on the newfound importance of systolic pressure (the top number) in the diagnosis and treatment of hypertension in middle-aged and older adults. According to NHLBI Director, Dr. Claude Lenfant, "it's a better blood pressure indicator than diastolic of your risk of heart disease and stroke."

In an effort to educate health professionals, community organizations, and the general public, NHLBI has launched a new campaign to raise awareness of this important new finding. As most of our readers hopefully know by now, high blood pressure (hypertension) is a very serious condition that affects 50 million Americans, or one in four adults. High Blood pressure is a serious risk factor for heart disease and stroke. Untreated, high blood pressure can also lead to conditions such as kidney damage and blindness. For these reasons, the NHLBI's advisory is especially important.

The new evidence suggesting that systolic blood pressure is the key determinant for assessing the presence and severity of high blood pressure for middle-aged and older adults comes from research such as the long-term Framingham Heart Study. According to the NHLBI, this study "showed that systolic blood pressure alone correctly identified 91 percent of those who may need antihypertensive therapy, while diastolic blood pressure alone correctly identified only 22 percent of them. Among those over age 60, systolic blood pressure alone was even better able that diastolic pressure alone to correctly classify blood pressure. The study involved nearly 5,000 persons."

Blood pressure is the measure of the force of blood flowing against artery walls. Systolic pressure occurs when the heart is actively pumping. Diastolic is the pressure on the arteries when the heart is at rest. Research suggests that diastolic blood pressure rises until around age 55 and then declines. Systolic pressure, on the other hand, increases steadily with age. According to the HBLBI, "for many older Americans, only the systolic blood pressure is high, a condition known as 'isolated systolic hypertension,' or ISH (systolic at or above 140 mm Hg and diastolic under 90 mm Hg). In fact, for older Americans, ISH is the most common form of high blood pressure. Sixty-five percent of all hypertensives over age 60 have ISH." Unfortunately, older Americans have the poorest rate of hypertension control. It is estimated that only 18% of white American hypertensives over the age of 70, and 25% of African Americans have blood pressure under control to less than the140/90 mm Hg standard.

Research has shown that controlling ISH significantly reduces heart attack, heart failure, and stroke. Do you know if you are among the millions of at-risk Americans with high blood pressure? Do you know if your systolic pressure is above 140 mm Hg? Regardless of your age, it's important to know your blood pressure and to seek treatment early to prevent organ damage, heart disease, and stroke. Have your blood pressure taken often, or take it yourself with a home monitor. Keep a record of your blood pressure readings and share it with your doctor. Talk to him or her about your blood pressure readings. Importantly, if you are currently taking medication for high blood pressure, don't stop taking it without consulting with your physician. If the medication you are taking is causing undesirable side effects, ask your doctor to prescribe another medication that might be more agreeable. For your health's sake, please don't ignore this important advisory!

High Blood Pressure

The Silent Killer

Did you know...

  • It is estimated that as many as 50 million Americans have hypertension, or high blood pressure as it is more commonly called?
  • More than 1/3 don't even know that they have it, and
  • Only about 21% are taking adequate steps to keep it under control!

What is High Blood Pressure?

Hypertension is the medical term for what most people call High Blood Pressure. Blood pressure is the measure of the force of blood flowing against artery walls. A blood pressure reading involves two numbers, which are separated by a slash mark. The first corresponds to systolic pressure, which occurs when the heart is actively pumping. The second corresponds to diastolic pressure, or pressure on the arteries when the heart is at rest. Normal blood pressure is usually considered 120/80. The National Heart Lung and Blood Institute has published the following standards for assessment of high blood pressure:

Category Systolic Diastolic
Normal < 130 < 85
High Normal 130-139 85-89

   Stage 1 (Mild)

140-159 90-99

   Stage 2 (Moderate)

160-179 100-109

   Stage 3 (Severe)

180-209 110-119

   Stage 4 (Very Severe)

>=210 >=120

It is important to have your blood pressure checked regularly by your doctor. High blood pressure can most often be controlled through medication, exercise, diet, or some combination of these actions.

New Advisory On Systolic Blood Pressure »

Heart Rate or Pulse

What you should know about your
Heart Rate or Pulse

Knowing how to measure your heart rate or pulse, can help you to learn about your own degree of fitness and can help to detect potential medical problems that should be brought to the attention of your physician.

» What Is Heart Rate?

» How To Measure Your Pulse

» What Is A Normal Heart Rate?

» Reducing Your Heart Rate

» Target Heart Rate

» Recovery Heart Rate

» A Final Word on Exercise Programs

What Is Heart Rate?

Very simply, your heart rate is the number of times your heart beats per minute. You can measure your heart rate by feeling your pulse - the rhythmic expansion and contraction (or throbbing) of an artery as blood is forced through it by the regular contractions of the heart. It is a measure of how hard your heart is working.

Your pulse can be felt at the wrist, neck, groin or top of the foot - areas where the artery is close to the skin. Most commonly, people measure their pulse in their wrist. This is called the radial pulse.

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How To Measure Your Pulse

Taking your pulse is easy. It requires no special equipment, however, a watch with a second hand or digital second counter is very helpful.

  1. Turn the palm side of your hand facing up.
  2. Place your index and middle fingers of your opposite hand on your wrist, approximately 1 inch below the base of your hand.
  3. Press your fingers down in the grove between your middle tendons and your outside bone. You should feel a throbbing - your pulse.
  4. Count the number of beats for 10 seconds, then multiply this number by 6. This will give you your heat rate for a minute.


If you count 12 beats in the span of 10 seconds, multiply 12 X 6 = 72.
This means your Heart Rate or pulse, is 72 (or 72 beats per minute).

Another popular way to measure pulse rate is by measuring it at the neck (carotid pulse). This is especially convenient during exercise. The formula is the same as above, however, when taking the pulse at the neck, place your fingertips gently on one side of your neck, below your jawbone and halfway between your main neck muscles and windpipe.

Taking your pulse upon rising in the morning, or after sitting without activity for about 10 minutes, is know as your Resting Heart Rate.

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What Is A Normal Heart Rate?

A Resting Heart Rate anywhere in the range of 60 - 90 is considered in the normal range. Your Heart Rate will fluctuate a lot depending on such factors as your activity level and stress level. If however, your pulse is consistently above 90, you should consult with your physician. This condition is called tachycardia (increased heart rate).

Many athletes have pulse rates in the 40 - 60 range, depending on how fit they are. In general, a lower pulse rate is good. Sometimes however, one's heart rate can be too low. This is known as bradycardia and can be dangerous, especially when blood pressure gets too low as well. Symptoms include weakness, loss of energy and fainting. If this situation applies, medical attention should be sought immediately.

If the pattern of beats or throbs you count is irregular (i. e. a beat is missed) take your pulse for a full minute. If you experience irregularities in your pulse on a consistent basis, you should consult with your personal physician.

Many factors influence heart rate. These include emotions, temperatures, your position or posture (sitting, standing, laying down), and your body size (if you are overweight for your size, your heart will have to work harder to supply energy to your body).

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Reducing Your Heart Rate

A decrease in resting heart rate is one of the benefits of increased fitness due to exercise. Before starting into any exercise regimen, however, be sure to consult with your personal physician.

Your heart is a muscle and will respond just like any skeletal muscle in that it will become stronger through conditioning. If your heart muscles are stronger, then your heart rate will decrease. In other words, your heart will be putting out less effort to pump the same amount of blood.

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Target Heart Rate

When undertaking an exercise program it is important to have a goal and a target range that you are trying to accomplish in each workout. To be of benefit, you want the workout to be neither too hard nor too easy. There is a simple formula to predict your maximum heart rate that is used in the fitness industry:

Take 220 and subtract your age.

This will give you a predicted maximum heart rate.

For example, if you are 42 years old, subtract 42 from 220 (220 - 42 = 178). This means that your maximum physiological limit as to how fast your heart should beat is 178 beats per minute.

Most exercise programs suggest that when someone is just getting started that their heart rate during exercise should not exceed 60 - 70% of their maximum heart rate. Therefore, given the example above, 60% of 178 = 107 beats per minute. As you progress in your exercise, the percentage of your maximum heart rate to be set as a goal can be gradually increased.

Calculating a target heart rate zone is often desirable. To do so:

  1. Start with your maximum heart rate as shown above.
  2. Multiply your maximum heart rate by 0.8 to determine the upper limit of your target heart rate zone (divide this product by 6 to get the rate for a ten-second count).
  3. Multiply your maximum heart rate by 0.6 to determine the lower limit of your target heart rate zone (divide this product by 6 to get the rate for a ten-second count).


For a person 42 years old:

220 - 42 = 178 Maximum Heart Rate

178 X 0.8 = 142 Upper Limit of Target Heart Zone (142/6 = 24,10 sec. count)

178 X 0.6 = 107 Lower Limit of Target Heart Zone (107/6 = 18, 10 sec. count)

Note: Your maximum heart rate is the most your heart should reach after a strenuous workout.

Your Heart Rate should be measured during warm-up, halfway into your workout, at the end of your workout and at the end of your cool-down period. If during exercise you exceed your upper limit, decrease the intensity of your workout. Conversely, at the end of your workout if your heart rate is much lower than your target, you need to work harder next time.

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Recovery Heart Rate

One way to determine if you are reaping the benefits from exercise is to calculate your Recovery Heart Rate, a measure of how quickly you return to your resting heart rate after a workout. To calculate your recovery heart rate:

  1. Take your pulse ten seconds immediately after you have finished exercising. Write down the number.
  2. One minute later, take your pulse again and write it down.
  3. Subtract the number for the second pulse check from the number for the first pulse check. This number is your Recovery Heart Rate. The greater the number, the better shape you are in!

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A Final Word on Exercise Programs

Exercise programs help to increase the strength of the heart. Declines will be seen in resting heart rate, and hopefully, blood pressure, and stress levels as well. Overall body changes will also be experienced including weight loss and increase of lean body mass.

Remember, however, that it is important to check with your doctor and seek out a qualified exercise physiologist before your get started. An exercise stress test may be advised to help ensure the training parameters that are best for you.

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