Expert: Domenic Sica - 9/19/2009

Question
QUESTION: I'm a 58 yr. old male, not over weight and don't smoke. I do take medication to lower cholesterol. I walk 5-6 days a week for 45 minutes. In the morning, before I walk when blood pressure can be at its highest, my systolic can be as high as 135-140 and
diastolic around 90. But after exercising mid-morning, I'll take my BP in the evening and it can be as low as 115/70 or less. I know readings flucuate, but is someone with those kinds of readings a candidate for medication? Thanks

ANSWER: That blood pressure range would not require treatment.  Congratulations on what I would view as very good blood pressures.

Regards,

Domenic Sica, M.D.

---------- FOLLOW-UP ----------

QUESTION: Ok, thanks. But what I'm concerned about is the BP readings in the morning before I exercise when it's 135/90, don't the current guidelines say it should be below 120/80? That's my concern.

ANSWER: I am not aware of any guidelines that state that morning blood pressure should be less than 120/80 mm Hg. If your thought is that you want to see morning blood pressure lower than I would suggest the following: obtain morning readings for several days and average the value, chart your duration and quality of sleep with each value in that sleep quality and amount has a dominant effect on blood pressure in the early morning, once this information is in hand either share it with your treating physician so a discussion can be had as to what is the best blood pressure for you or if you want I would be happy to offer some additional thoughts.

Regards,

Domenic Sica, M.D.

---------- FOLLOW-UP ----------

QUESTION: Thanks, I thought when they say BP should be less than 120/80, they meant most of the time, including morning. Or am I mistaken and it is is ok for it to be a lot higher than that in the morning, as long as the average is less than 120/80? Thanks

Answer
Your question is a complex one and not easily answered by the Internet but I will try. Currently optimal blood pressure is 120/80 but we do not treat hypertensive patients to bring them to this value nor do we generally initiate therapy unless blood pressure exceeds 140/90 [with the exception of diabetics, kidney disease, and coronary artery disease patients where we start treatment when blood pressure exceeds 130/80]. If your morning reading is higher that the daytime reading yet it is still in the "normal" range few physicians would treat the morning reading unless it is reproducibly and significantly higher than your very normal daytime readings and even then your normal daytime readings would be brought lower with the potential for side-effects.  Most patients have variable blood pressure readings throughout the day with morning readings being the highest. In patients referred to me with your type question I typically treat the average 24-hour reading, which in your case I would imagine would be in a very normal range.

Regards,

Domenic Sica, M.D.