(CBS4) – For years, the magic number for blood pressure was 140 over 90 or lower. Meaning the top number, or systolic, shouldn’t be above 140, and the bottom number or diastolic, shouldn’t be above 90. (The systolic is the pressure in the heart works against when it pumps blood out, and the diastolic is the pressure between beats, when the heart is resting.)

In most people, the numbers were thought to be equally important. But a few months ago, a study came out that said the 140/90 wasn’t a safe as we thought — instead we should be shooting the get that top number to 120 or lower, especially in people age 50 and older.

The study had more than 9,000 people in it, and the results were so striking and so positive that the study was abruptly halted.

It seems people who get and stay at that 120 mark or lower have a big drop in risk of heart attacks, strokes, and heart failure — the rates of death from those diseases also drop like a rock.

So today we doctors are being told not to be satisfied when someone comes into the office and gets a reading of 132/86 — meaning you can forget the pat on the back — instead get ready for marching orders over to the pharmacy for some pills.

I should note that the study really only scoped out that top number. Is the bottom okay at 90 or touch lower? We’re thinking probably not — maybe we should be shooting for a 70 or 80 max. Meaning a 120/70 would be ideal. And probably not just for ages 50 and older — but all adults.

Now you know that losing weight, limiting salt, stubbing out the smokes, and getting some exercise will help get your numbers into a nicer range. But I have patients who are in perfect health and have perfect habits, yet still ring the high blood pressure bell. Those are the folks for whom you just accept the fact that despite their best efforts, have genetics that spell a diagnosis of high blood pressure at some point in their lives. (Heck, I have a marathoner who weighs 155 pounds and eats like a sparrow, yet still needs medication).

So give it your best shot, but don’t be bummed if your genes are battling you. It’s not your fault.

Now, living longer is an obvious pro to lowering BP. But are there any cons? Sure. Some people just don’t do well with lower blood pressure. They are tired. They get dizzy spells. They feel faint when they stand up. They have side effects from the medication. The drugs put a strain on their kidneys. Yep, it’s a balancing act. But like it or not, the rules have changed.

So it’s official:  Lower is better, and we are going to push you to get there after decades of having what used to be “normal” blood pressure.

Some closing thoughts:  You need to have your blood pressure taken properly or you may get misdiagnosed. So when you go into the office and brought back to the exam room, you should:

  • Be allowed to sit quietly for several minutes before the cuff is slapped on.
  • You need to sit in a chair with back support
  • Your feet should be flat on the floor
  • Your arm should be held and supported at heart level (in other words, don’t hold it up yourself.)
  • You need to be tested with the proper sized cuff (if you have big arms and are checked with conventional cuff, you’re going to read high.)
  • And if you do read high, your pressure should always be checked again later in the visit. (I know us doctors can scare you up a few points — it even happens to me when I go in for a checkup!)


Good luck. It’s a new thing for all of us. But it does look like a lot more of us are going to be popping a pill from now on every day. (And by the way, generic BP pills are just as good as the name brands.)

Source: New England Journal of Medicine

Dr. Dave Hnida is CBS4’s Medical Editor. He blogs about the latest studies and trends in the health world. Read his latest blog entries, check out his bio or follow him on Twitter @drdavehnida.