Elevated blood pressures in the medical setting may not necessarily reflect the individuals real status. "White coat hypertension" describes a patient whose blood pressure is elevated because of the stress of the visit to the doctor or other healthcare professional, and the worry that their blood pressure might be elevated. Repeated blood pressure checks at the doctor's office or the use of a home blood pressure monitoring device may be used to confirm that you have high blood pressure.
Heart disease, stroke, and other cardiovascular (blood vessel) diseases are among the leading cause of death and now kill more than 800,000 adults in the US each year. Of these, 150,000 are younger than age 65. These diseases are also two of the leading causes of health disparities in the US. Treatment of these diseases accounts for 1 in every 6 US health dollars spent. Two main reasons people have heart disease or stroke are high blood pressure* and cholesterol, which are common, deadly, and preventable. Nearly 2 out of 3 adults with high cholesterol and about half of adults with high blood pressure don’t have their condition yet under control. Clearly, other steps are needed to gain control of these health risks.
Though essential hypertension remains somewhat mysterious, it has been linked to certain risk factors. High blood pressure tends to run in families and is more likely to affect men than women. Age and race also play a role. In the United States, blacks are twice as likely as whites to have high blood pressure, although the gap begins to narrow around age 44. After age 65, black women have the highest incidence of high blood pressure.
However, it’s possible to have a high systolic blood pressure and a normal diastolic blood pressure, or vice versa. Having a high systolic blood pressure and normal diastolic blood pressure, referred to as isolated systolic hypertension, is actually common among older adults and can lead to serious health problems. And research suggests that isolated systolic hypertension may be on the rise in young adults, potentially putting millions of individuals at risk for heart disease and stroke.

Doctors typically use an inflatable arm cuff to measure blood pressure, which is recorded in millimeters of mercury (abbreviated as “mmHg”) and has two numbers. The top number, called systolic blood pressure, measures pressure in the arteries when the heart beats. The bottom number, called diastolic blood pressure, refers to blood pressure when the heart is at rest. When patients have a blood pressure above normal (120/80 mmHg), they are considered to have prehypertension or hypertension.

For older people, often the first number (systolic) is 130 or higher, but the second number (diastolic) is less than 80. This problem is called isolated systolic hypertension, which is due to age-related stiffening of the major arteries. It is the most common form of high blood pressure in older people and can lead to serious health problems (stroke, heart disease, eye problems, and kidney failure) in addition to shortness of breath during light physical activity, lightheadedness upon standing too fast, and falls. Isolated systolic hypertension is treated in the same way as regular high blood pressure (130 or higher for the first number, or 80 or higher for the second number) but may require more than one type of blood pressure medication. If your doctor determines that your systolic pressure is above a normal level for your age, ask how you can lower it.
Prehypertension: When your blood pressure is slightly higher than the normal 120/80, but lower than 140/90, it’s called prehypertension. Prehypertension can raise your risk for heart disease and stroke, so doctors will often recommend lifestyle changes, such as exercise and healthier eating habits, to help lower your blood pressure to the normal range.
Exercise stress test: More commonly used for patients with borderline hypertension. This usually involves pedaling a stationary bicycle or walking on a treadmill. The stress test assesses how the body's cardiovascular system responds to increased physical activity. If the patient has hypertension this data is important to know before the exercise test starts. The test monitors the electrical activity of the heart, as well as the patient's blood pressure during exercise. An exercise stress test sometimes reveals problems that are not apparent when the body is resting. Imaging scans of the heart's blood supply might be done at the same time.
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