Walk into your family doctor’s office for a physical examination. Of the many tests that may be performed, your blood pressure will almost certainly be checked. This is because blood pressure is a well-known measurement of cardiovascular health that gives insight into the inner workings of your heart, and your overall state of health.

When your heart beats, pressure is exerted both in the vessels in the heart and in the arteries, delivering blood, oxygen, and nutrients to the body. Between heartbeats, the heart rests and importantly, this pressure level drops. Blood pressure measurement, which is measured in “millimeters of mercury” or mmHG, shows you if these pressure levels are acceptable or if there may be cause for concern.    

In this article, we will discuss more about blood pressure readings, including risks associated with prolonged elevated blood pressure. We will also talk about the different methods of measuring blood pressure, and whether any particular method has proven superior. We will delve further by exploring other related markers of cardiovascular health. Let’s begin.

Blood Pressure: Systolic and Diastolic

Take a seat in your doctor’s office. A cuff is placed around your arm and a blood pressure reading is taken, consisting of two numbers, one normally larger than the other.  A typical blood pressure reading is recorded as a systolic pressure first (shown on top) and diastolic pressure second (shown on bottom), with your total blood pressure reading given as a result. These two numbers paint of picture of the forces being placed upon your heart and the blood vessels within your body.

Systolic pressure, the typically higher number in the reading, measures the force (or pressure) that your heart exerts with each heartbeat. Diastolic blood pressure, or the typically lower number in the reading, measures the force that is placed upon your heart while it is at rest (or between beats). Both of these numbers are important and give you and your health practitioner valuable insight into your heart health. These numbers are used to classify your blood pressure range as anywhere from “Normal” to “Stage 2 Hypertension”. We will discuss more about blood pressure ranges later on.

Why Monitor Blood Pressure?

As we have discussed, blood pressure is an important marker of cardiovascular health, but just what does that mean exactly? Commonly referred to as the “Silent Killer” , high blood pressure is often asymptomatic. Occasionally, a person may suffer from headaches or vomiting as a result of high blood pressure, however for most people, symptoms of high blood pressure are rare and thus high blood pressure may go undetected. Prolonged high blood pressure increases your risk for developing a number of other health conditions including:

• Heart attack: High blood pressure can damage arteries and prevent blood flow to the heart muscle.

• Stroke: Elevated blood pressure promotes your risk of stroke due to clotting in the arteries or potential bursting of the blood vessels.

• Kidney disease: High blood pressure can stress kidneys and negatively affect their ability to filter.

• Sexual Dysfunction: Erectile dysfunction and libido problems have been linked to high blood pressure.

• Angina: High blood pressure can lead to heart disease and chest pain, otherwise known as angina.

• Peripheral Artery Disease: Narrowing of the arteries, often caused by atherosclerosis, can cause pain in arms, legs, stomach and head, and may increase your risk for other cardiovascular diseases.

High blood pressure when high for too long, creates stress on your blood vessels. Bad cholesterol, or “LDL cholesterol”, may accumulate in weaknesses or tears in the artery walls, promoting atherosclerosis and potential clot formation. The heart then, in essence, must work harder to pump blood throughout the body, therefore increasing your risk for a variety of cardiovascular and cerebrovascular events. Regularly monitoring your blood pressure and following up with your healthcare practitioner with any concerns are important steps in protecting that very valuable heart muscle and other essential organs.  

Blood Pressure Measurement: The Basics of Measurement

Blood pressure is typically taken in the upper arm, over the brachial artery. Although this may seem straightforward and simple, a variety of methods of blood pressure measurement exist.  

Auscultatory Method

This method uses a mercury sphygmomanometer (or blood pressure cuff) and is typically regarded as ‘gold standard’ for in office blood pressure measurement. Typically used in the clinical setting, a cuff is placed around the upper arm, is inflated, and then the practitioner uses a stethoscope and listens for what is known as ‘Korotkoff’ sounds, or the sounds of pulsatile blood flow as the cuff is deflated.

This method of blood pressure measurement is less common than it once was due to a wide-spread ban on mercury sphygmomanometers, due to the risks associated with the usage of mercury. Hybrid devices have been developed which combine both electronic and auscultatory methods, replacing mercury usage with an electronic pressure gauge. These devices require proper training of the health practitioner and frequent calibration to ensure the accuracy of blood pressure measurements.  

Oscillometric Technique

The Oscillometric Technique forms the basis for home blood pressure monitors and other electronic monitors used in various settings. As the blood pressure cuff is gradually deflated during usage, the oscillations recorded by the device begin at approximately systolic pressure and continue below diastolic pressure. Blood pressure is then estimated empirically, using a specific formula. This method has been found to be comparable to the auscultatory method, and may present a number of advantages as well.

• Convenience: This technique makes home-usage and out of clinic usage possible, reducing the need for regular measurement by a healthcare practitioner.

• Elimination of practitioner error: A major advantage as there is no reliance on proper training of blood pressure measuring techniques, including factors such as selecting the right cuff size and position, recognizing subject factors such as anxiety, proper use of the auscultatory method using a stethoscope and correct recording.

• Elimination of white coat syndrome: The presence of a medical doctor taking blood pressure has been identified as a factor influencing higher blood pressure readings.  

• Multiple Readings: Allows for a higher number of readings daily, which is ideal for regular monitoring of blood pressure.

For those with high blood pressure, the American Heart Association recommends “home monitoring for all people with high blood pressure”. This allows for regular monitoring and reporting to your healthcare practitioner. A single elevated reading is not typically cause for concern, but home monitoring allows you to easily and regularly check your readings yourself, promoting better heart health.

How to Measure Blood Pressure Correctly

A number of factors can affect your blood pressure reading. According to the American Heart Association, you should not smoke, drink caffeinated beverages or exercise for 30 minutes prior to taking a blood pressure reading.  Five minutes of rest and an empty bladder are recommended before commencing a blood pressure check. You should be seated in a supported chair, with your feet flat on the floor and your arm should be supported on a surface at heart level. Blood pressure should typically be taken at the same time every day, such as morning and evening, and you should take two to three readings at a time, spaced by a minute apart.

Blood Pressure Readings

There are five blood pressure ranges recognized by the American Heart Association. These ranges should best be utilized in terms of consistent readings at these levels, as opposed to one isolated reading. It is important to distinguish that these ranges use the words “and” and “or” specifically:

• Normal Blood Pressure: Less than 120 mmHg systolic and less than 80 mmHg diastolic.

• Elevated Blood Pressure: 120-129 mmHg systolic and less than 80 mmHg diastolic.

• Hypertension Stage 1: 130-139 mmHg systolic or 80-89 mmHg diastolic.

• Hypertension Stage 2: 140 mmHg or higher systolic or 90 mmHg or higher diastolic.

• Hypertension Crisis: If your blood pressure suddenly exceeds 180/120 mmHg, wait five minutes and then test your blood pressure again. Contact your doctor immediately your blood pressure remains in this range.

Both systolic and diastolic blood pressure matter. For those over the age of 50, typically systolic blood pressure is given more weight as a major cardiovascular risk factor. This is because the systolic blood pressure will generally rise with age as arteries naturally stiffen and as a result of long-term plaque build up. Research however describes that the risk of death from ischemic heart disease and stroke doubles for every pressure increase of 20 mmHg systolic or 10 mmHg diastolic in those aged 40-89.  

Further interpretation of your readings

As we have discussed, to lower your risk of various health conditions, it is important to know your blood pressure scores and to monitor and contact your health professional if readings are consistently abnormal.

The BPBIO 320S, by InBody USA, is a fully automated and easy to use oscillometric blood pressure monitor that is voice guided, has a single-step measurement process, and has an elbow sensor for more accurate results with high reproducibility. This device has met the requirements of the European Society of Hypertension International Protocol validation protocol, showing that it can be recommended for clinical use in adults. The BPBIO 320S measures Systolic Blood Pressure, Diastolic Blood Pressure, Pulse Pressure, Mean Arterial Pressure, Pulse Rate and Rate Pressure Product.   

We have already discussed systolic and diastolic blood pressure in detail.  Pulse Pressure (PP), which is the difference between systolic and diastolic blood pressure, and Mean Arterial Pressure (MAP), which is the average pressure in the arteries during a cardiac cycle, are well established markers of cardiovascular health. In a large study of 2311 subjects with essential hypertension, 24 hour blood pressure monitoring showed that PP is a major predictor in cardiac events and that MAP is a major predictor in cerebrovascular events. In addition, both PP and MAP have been found to be associated with ischemic stroke in hypertensive individuals. Rate Pressure Product, which is an indicator of oxygen requirements of the heart, has been used to assess cardiovascular fitness and the risk of coronary artery disease.

Know Your Numbers!

It is important to be aware of your blood pressure score, as blood pressure is a reliable indicator of cardiovascular health. High blood pressure is associated with a number of health risks and making a habit to regularly monitor your blood pressure is a healthy one!   

Oscillometric blood pressure devices have made it easier than ever to check your blood pressure regularly, lessening the reliance on that once a year physical examination and putting you more in control of your health. Normal blood pressure, defined as less than 120/80 mmHg, combined with other markers of cardiovascular health such as Pulse Pressure, Mean Arterial Pressure and Rate Pressure Product, give valuable insight into your current health and potential risk level. Should you have blood pressure readings that are consistently abnormal, be sure to monitor and discuss these results with your health professional.

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Dr. Jennifer Malowney is a practicing chiropractor, with an interest in preventative health.  Her knowledge and clinical experience in the areas of health, fitness, and nutrition offer readers an informed and well-researched perspective.   

Many lifestyle factors can cause high blood pressure, including stress, eating too much salt and trans fats, and a lack of physical activity. Being overweight has long been identified as a risk factor for high blood pressure, also known as hypertension, regardless of age group. When you carry excess body weight it can take more pressure to move the blood around the body, known as resistance to flow. In other words, your heart must work much harder than it would at a healthy body weight. Obesity is also associated with other conditions, such as sleep apnea and diabetes, that carry an increased risk of high blood pressure.

What many people may not know is that being “overfat” – having excess body fat even at a normal weight – is also shown to affect blood pressure. What do these associations mean for us? By taking control of your body composition, you can keep your blood pressure under control, improve your cardiovascular health, and enjoy many other long-term health benefits.

Understanding Blood Pressure Readings

As your heart beats, it pumps your blood throughout your body so that your muscles can get all the energy and oxygen they need. To do this, your heart pushes your blood through a network of blood vessels called arteries.

When the blood travels through the arteries, it pushes against the sides of these blood vessels and the strength of this pushing is called your blood pressure. Your heart squeezes and pushes your blood through your arteries, making your blood pressure go up. The pressure created in the blood vessels while the heart is active, or beating, is your systolic blood pressure. Systolic blood pressure will be the first number in your blood pressure reading. As your heart relaxes and begins to refill with blood, the pressure in your blood vessels goes down. This is known as your diastolic blood pressure, which is the second number provided in a blood pressure reading.

So, what this means is that with each heartbeat, your blood pressure rises to a maximum level (systolic pressure) and then falls to a minimum level (diastolic pressure). Together, these maximum and minimum pressure values define your blood pressure.

First, you should be aware of how high blood pressure is categorized (Note: Blood pressure is reported in millimeters of mercury, or mmHg):

• Normal: <120 mmHg systolic BP and <80 mmHg diastolic BP

  • Elevated: 120-129 mmHg systolic BP and <80 mmHg diastolic BP

  • Hypertension stage I: 130-139 mmHg systolic BP or 80-90 mmHg diastolic BP

  • Hypertension stage II: > 140 mmHg systolic BP or >90 mmHg diastolic BP

  • Hypertensive Crises: >180 mmHg systolic BP or >120 mm Hg diastolic

What this means is that having a blood pressure of 130/80 or higher on a regular basis is considered to be placing too much pressure on the blood vessels. Having consistently high blood pressure can eventually cause damage to the heart and blood vessels, leading to cardiovascular disease. 

Why the Location of Your Body Fat Matters

People with fat around their abdominal area are at greater risk of developing hypertension when compared to those with a similar BMI who primarily have fat concentrations elsewhere on the body.

You have two types of adipose tissue (body fat): subcutaneous and visceral fat. Subcutaneous fat lies just under your skin around the belly, thighs, rear, and extremities. Visceral fat lies below your abdominal muscles and encircles your organs. Depending on your body type, you may be unaware that you have a high level of visceral fat if you only rely on BMI. 

When the weight gain is in the abdominal area, there’s a greater risk for high blood pressure because this type of body fat is more likely to cause the arteries to become thick and stiff. When your blood vessels get stiff, it becomes harder to push the blood throughout your body. The body then has to create more pressure to move the blood, which may lead to a lasting increase in blood pressure.

Additionally, visceral fat is thought to interact more intimately with the kidneys and adrenal glands, which are responsible for regulating your blood pressure. By interfering with the function of those organs, visceral fat is a serious promoter of high blood pressure.

Am I at Risk for Hypertension?

There are several risk factors for hypertension, and it’s important to know what they are so you can monitor your health.

Some risk factors for high blood pressure are non-modifiable, meaning you can’t really do anything about them. Those include your family history; age; gender; race; and whether you have a history or presence of chronic kidney disease (CKD).

Modifiable risk factors are those you can take control of to reduce your risk for high blood pressure. Those include physical activity level; diet; weight; body fat percentage; alcohol use; smoking and tobacco use; sleep apnea; diabetes; high cholesterol; and stress.

How to Lower Your Blood Pressure By Focusing on Body Composition

The good news is that when you lose weight (even a small amount), your blood pressure can go down and your blood vessels can loosen up, making it easier for your heart to pump blood throughout your body. Losing body fat, especially around the belly, can lower the risk of developing blood pressure and, potentially, completely eliminate high blood pressure. Losing weight all around helps tremendously, too.

Lowering your blood pressure will take a number of new healthy habits. Some changes you can make that may help manage high blood pressure include:

• Eat a well-balanced diet that’s low in salt

• Limit alcohol

• Enjoy regular physical activity

• Manage stress

• Maintain a healthy body composition

• Quit smoking

• If you’re on medication, take your medications properly

• Keep track of your body composition

• Test your blood pressure

Successful, long-term weight loss is the key to sustained cardiovascular health. You should get your body composition tested regularly to make sure you’re losing fat mass (and not muscle) – especially the deep, visceral fat that contributes heavily to hypertension.

Exercising with High Blood Pressure

Physical activity is critical for managing hypertension – and body composition – but it must be done wisely. Some types of exercise, such as very heavy lifting and isometric exercises, increase blood pressure temporarily but still may be able to reduce resting blood pressure, so consult your doctor to plan your approach before beginning a new activity routine.

The American Heart Association recommends that people with high blood pressure carry out an average of 150 minutes (two and a half hours) of moderate- to vigorous-intensity workouts every week. Moderate describes activities like brisk walking and cycling, while vigorous includes running, interval training and other activities that demand more energy to complete.

Light-to-moderate weight training can also help you manage hypertension. One study found that just twelve weeks of consistent resistance exercise can reduce systolic blood pressure by 22 mmHg and diastolic blood pressure by 8 mmHg.

If you have high blood pressure, start strength training with weights you can lift 10-15 times without breaking your form. Make sure to breathe consistently during weight training, because holding your breath for too long can increase your blood pressure.

Your body’s blood vessels dilate during exercise in order to supply your working muscles with more oxygen and nutrients. After exercise, blood vessels tend to remain slightly dilated and relaxed, which makes it easier for your heart to pump blood throughout your body.

The best way to improve your body composition, and thus your blood pressure level, is to mix resistance training with aerobic activity. By building muscle, your body will start to burn more calories at rest than it did before. This will help reduce fat all throughout your body, including the visceral fat around the organs. Aerobic exercise like walking, running and swimming increases the heart’s efficiency, vein elasticity, and overall cardiovascular fitness. But, like when starting any new exercise routine, start slow and see what feels most comfortable, and safe, for you.

Eating to Improve Blood Pressure

In addition to a consistent exercise plan, improving your diet is a surefire way to decrease fat mass and lower blood pressure. A healthy diet that promotes low blood pressure readings includes ample portions of fruits and vegetables; low-fat dairy products; skinless poultry and fish; some whole grains; and healthy fats like nuts, legumes, and oils made with mostly unsaturated fats (like olive or grapeseed oil).

By making sure you consume enough of those foods, you naturally crowd out most of the foods and ingredients that contribute to high blood pressure: sodium, trans and saturated fats, red meats, and added sugar.

Meal planning and prepping are the two best methods to stick to a healthy eating regimen. Almost everyone who is successful in changing their body composition and improving health follows some sort of plan. This guide to changing – and maintaining – your body composition will help you get started.

Summing It Up

Not all belly fat is created equal. The deep fat mass surrounding our organs is far more dangerous than the fat lying just beneath the skin and may increase risk for high blood pressure, among other health conditions. And the more belly fat you have, the more likely you are to have visceral fat around your organs.

It’s not just whether you’re overweight but how you carry that extra weight that impacts your risk for high blood pressure. The good news is that all types of belly fat, including visceral fat, disappear with weight loss. Through healthy lifestyle choices like maintaining a healthy diet and getting active, belly fat can be reduced, improving cardiovascular health and body composition.

By focusing on improving your body composition (and monitoring your progress closely), you’ll shed body fat and improve your blood pressure, among other health benefits of losing fat.

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Amanda Capritto is a certified personal trainer and health coach who writes about nutrition, fitness, and healthcare. A journalism alumna of Louisiana State University, Amanda spends her free time adventuring outdoors, hitting the gym, and encouraging people to live balanced, healthy lifestyles.