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PaperclipPerfector  6d ago (text post)   1728 thread views

Small-Scale Question Sunday for January 4, 2026

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My blood pressure was actually decent for the first time in years yesterday when I gave blood. It was 114/66. Usually it's like 119/71 or something. I blame the cardio, the lifting, and the dieting. Probably mostly the cardio though.

What are some changes that you've made to your life that you noticed results for?

Isn’t 119/71 just fine?

That's what some blood center employees told me, but I think it's right up against the edge of "elevated" blood pressure. So it's kind of like having a BMI of 24.9: sort of okay, but you can do better. I think lower is probably better.

119/71 is not right up against the edge of "elevated" blood pressure at all but completely normal.

Just to better classify the risk factors for cardiovascular events (sudden cardiac death, heart attack, stroke, essentially):

First of all, blood pressure is one risk factor among many. The fewer risk factors you have, the more relaxed you can be. The two main risk factors are age (!) and gender (male), followed by: smoking, diabetes mellitus, hypercholesterolemia, family history of disease (not your grandmother who had a stroke at 80, but a cardiovascular event before the age of 55 in men and 65 in women), and hypertension. And no, BMI alone is not an independent risk factor.

Secondly, the risk associated with high blood pressure follows a J-curve. See, for example: https://www.nature.com/articles/s41440-024-01593-y (page 1552). At a blood pressure of <110 mmHg, the risk increases again... Between 120-135 mmHg, nothing changes, nor does anything happen at 70-85 mmHg. Hence the recommendation (in Europe at least): <140/90 mmHg, and <135/85 mmHg for high-risk patients.

Unfortunately, the pharmaceutical industry is constantly trying to invent new diseases, push boundaries, and influence guidelines. This is not a conspiracy theory; anyone in the healthcare sector would confirm this, and you only need to look at the guidelines from the last 30 years. As HereAndGone2 writes: " Blood pressure categories in the new guideline are: Normal: Less than 120/80 mm Hg; Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80; Stage 1: Systolic between 130-139 or diastolic between 80-89; Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg; Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage." That is definitely not evidence-based.

Finally, one more consideration: let's assume a person is 40 years old, has no risk factors except perhaps slightly elevated cholesterol, does exercise, is fit. His cardiovascular risk is 2% in 10 years with a blood pressure of 125/75 mmHg. The same person develops a blood pressure of 150/90 mmHg. The risk increases by +40%. So, in absolute terms, 0.8% in 10 years. This means that treatment only makes sense if the side effect rate is <0.8%/10 years. Which medication can achieve this? The same person at age 75, risk 16% without blood pressure. With hypertension +6.4% in absolute terms – the risk-benefit ratio looks very different.

That's why I would never just look at values, but always assess the "total package."

Haha I am glad that I said something about this. Not that my blood pressure was ever bothering me, but your post and @HereAndGone2's post are both excellent information that I will remember for the future. Anyway, I will still feel happy about my numbers changing, because it indicates that my actions had an effect on the real world, even if it was mostly just neutral/insignificant.

Ah, I remember the days when 140/80 was fine and normal. Blood pressure limits have trended downwards a lot recently, and I don't know how much is "medical science now tells us that there is a valid reason" and how much is "lower is better, we have to at least pretend to be doing something so we'll keep setting limits lower and lower even if it makes no real difference".

Seems that the standards changed in 2017:

The guidelines were presented today at the Association’s 2017 Scientific Sessions conference in Anaheim, the premier global cardiovascular science meeting for the exchange of the latest advances in cardiovascular science for researchers and clinicians.

Rather than 1 in 3 U.S. adults having high blood pressure (32 percent) with the previous definition, the new guidelines will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, or hypertension. However, there will only be a small increase in the number of U.S. adults who will require antihypertensive medication, authors said. These guidelines, the first update to offer comprehensive guidance to doctors on managing adults with high blood pressure since 2003, are designed to help people address the potentially deadly condition much earlier.

...Paul K. Whelton, M.B., M.D., M.Sc., lead author of the guidelines published in the American Heart Association journal, Hypertension and the Journal of the American College of Cardiology, noted the dangers of blood pressure levels between 130-139/80-89 mm Hg.

“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” he said. “We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”

Blood pressure categories in the new guideline are:

Normal: Less than 120/80 mm Hg;
Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80;
Stage 1: Systolic between 130-139 or diastolic between 80-89;
Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

The new guidelines eliminate the category of prehypertension, which was used for blood pressures with a top number (systolic) between 120-139 mm Hg or a bottom number (diastolic) between 80-89 mm Hg. People with those readings now will be categorized as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89).

Previous guidelines classified 140/90 mm Hg as Stage 1 hypertension. This level is classified as Stage 2 hypertension under the new guidelines.

The impact of the new guidelines is expected to be greatest among younger people. The prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45 according to the report.

...Other changes in the new guideline include:

  • Only prescribing medication for Stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used in evaluating high cholesterol).
  • Recognizing that many people will need two or more types of medications to control their blood pressure, and that people may take their pills more consistently if multiple medications are combined into a single pill.
  • Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient’s plan of care.

120/70 is good enough for normal standards. Sure, if you're very fit and very sporty and very healthy and the right age, you can probably get it lower, but you'll run into "now it's too low, that's why I'm constantly slightly light-headed and low-level brain fog" territory if you go too low.

Also frequent fainting. My blood pressure was something like 105/60 before I gained weight during the pandemic, and I fainted about once a month.

Though more significantly, if you are just comparing two single point-in-time readings, the difference between 114/66 and 119/71 is within the range of normal day-to-day variation, and many people have slightly higher blood pressure in the doctor's office than they do elsewhere because of stress response.

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