Low-density lipoprotein cholesterol and survival in pulmonary arterial hypertension
How To Recognize Normal Versus High Blood Pressure
DEAR DR. ROACH: I have been confused about what normal blood pressure is for me (or anyone). I know there is some debate on what normal is today, but let us say that normal is 120/80 mm Hg. Does this mean that 110/90 mm Hg, 130/70 mm Hg, or 150/50 mm Hg is also normal? Is there any significance of the ratio between systolic and diastolic blood pressure? — L.P.
ANSWER: Because so many people have high blood pressure, and the consequences of untreated or poorly treated high blood pressure include a risk for heart attacks and strokes, it's critically important to understand this thoroughly.
For a young, healthy person, the lower the blood pressure, the lower the risk of blood vessel damage that leads to these dreaded complications of heart attack and stroke. I routinely see people with blood pressures of 90/60 mm Hg who are just fine (although they are a bit more likely to faint).
But for middle-aged and older people, we define blood pressure as normal when the systolic (first or top number) pressure is less than 120 mm Hg and the diastolic (the second or bottom number) is less than 80 mm Hg. Elevated blood pressure is when the systolic pressure is between 120-129 mm Hg and the diastolic pressure is less than 80 mm Hg. It's considered hypertension when the systolic number is 130 mm Hg or greater, or the diastolic number is 80 mm Hg or greater.
So, all of the readings you proposed are hypertension — not just elevated blood pressure.
Of course, the higher the reading (in general), the higher the risk of damage to the blood vessels and, after some years, the higher the risk of heart attacks or strokes. It's not the ratio of the systolic and diastolic numbers that is of interest; it's the difference between them (also called the pulse pressure). So, with the numbers you gave, the pulse pressures are 20, 60 and 100 mm Hg. Independent of blood pressure levels, a higher pulse pressure confers additional risk to the person, mostly because very stiff blood vessels cause a high pulse pressure. Different types of blood pressure medicines affect pulse pressure differently.
What's a good platelet count?
DEAR DR. ROACH: Is a platelet count of 135,000 low or in the normal range for a 76-year-old male in good health, with no signs of abnormal bruising or bleeding? — P.R.
ANSWER: The normal range for a platelet count is 150,000-450,000 per microliter, so 135,000 is just below the lower limit of normal. However, it's quite rare to have abnormal bleeding with a platelet count like this, even under stress like a surgical procedure.
About 2.5% of the healthy population will have a platelet count below 150,000, so a level of 135,000 may not represent any disease at all. Typically, the risk of spontaneous major bleeding becomes high when platelet levels drop below 30,000.
The most common cause of low platelets in older adults is an immune-mediated condition called "immune thrombocytopenia," but there are many possible causes, including medications, bone marrow diseases, and liver disease. For a 76-year-old, if repeat blood counts show that the platelet count is stable in the 100,000 range, most experts would not do further testing in absence of any symptoms.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu.
Your Smartphone Could Soon Measure Your Blood Pressure With Just A Touch
High blood pressure (or hypertension) increases the risk of health problems such as heart or kidney failure, but goes undiagnosed in millions of people.
A newly developed Android phone app is able to remotely estimate pressure in a person's arteries as their heart squeezes, providing potentially life-saving details on individual health without the need for specialized equipment.
Developed by a team led by researchers from the University of Pittsburgh, the app works by taking a variety of readings from the accelerometer, camera, and touch sensors built into modern smartphones.
Rather than having to take a trip to the doctor or use a dedicated device, individuals might one day be able to make use of the phone in their pocket, making the innovation particularly important in underserved populations where access to medical care is limited.
The user has some actions to follow. (Landry et al., Scientific Reports, 2024)
"In underserved populations, many people don't have access to blood pressure cuffs, regular doctor's appointments, or even know it's a problem – but they do have smartphones," says University of Pittsburgh biomedical engineer Ramakrishna Mukkamala.
Blood pressure is typically measured using a device with a tongue-twisting name, called a sphygmomanometer. An inflated cuff squeezes the arm's primary artery, pinching it shut, before slowly releasing the flow again.
With every heartbeat, the pressure shifts between contraction – referred to as systolic pressure – and relaxation – called diastolic pressure. The systolic pressure is presented as the higher number in a blood pressure reading, and the diastolic pressure the lower figure.
Some digital devices can tell the change automatically, though doctors can also use a stethoscope to listen for the pulse and judge the differences in pressure and record it as millimeters of mercury, or mm Hg. A systolic reading over around 130 mm Hg is usually interpreted as a cause to keep monitoring.
Smartphones can't apply pressure to stop and restart blood flow as a traditional blood pressure cuff does. As an alternative approach, the app uses the force of gravity and the force of finger pressure on the phone touchscreen to figure out pulse pressure.
What makes the app smart is the way it gets users to change the positioning of their hands to alter blood flow, and apply a number of instructed touches to the phone screen to get the right pulse pressure readings.
"Because of gravity, there's a hydrostatic pressure change in your thumb when you raise your hands up above your heart, and using the phone's accelerometer, you're able to convert that into the relative change in pressure," says biomedical engineer Vishaal Dhamotharan from the University of Pittsburgh.
In tests on 24 people and cross-referencing with a larger database, the app method was detected pulse pressure to a reasonably accurate level, within around 8 mm HG. As development continues, the app accuracy level will most likely improve on that even further.
The researchers admit they'll need to work on "changing the mentality" around using pulse pressure as a blood pressure indicator – but it's the best solution we've seen yet for taking this crucial reading using a normal smartphone.
"Development of a cuffless blood pressure measurement device that does not require any external calibration is the holy grail – such a device currently does not exist," says biomedical engineer Sanjeev Shroff, from the University of Pittsburgh.
"The research work reported in this publication is an important step in the right direction."
The research has been published in Scientific Reports.
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Eat These Expert-Recommended Foods To Lower Your Blood Pressure Naturally
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When we think about trying to lower high blood pressure, we usually think of limiting salt and processed foods. But, a heart-healthy diet is more than just lowering your sodium intake. The DASH diet (Dietary Approaches to Stop Hypertension), which is specifically designed to help manage blood pressure, emphasizes eating many fruits, vegetables, low-fat dairy, and other fiber-rich foods. Incorporating many of these foods that lower blood pressure into your diet can be a great way to naturally boost your heart health.
"The DASH diet is heart-healthy and is rich in foods that have a high content of calcium, magnesium, potassium, protein, and fiber," explains Marwah Abdalla, M.D., M.P.H., a cardiologist at New York-Presbyterian/Columbia University Irving Medical Center. These nutrients are essential to lowering blood pressure.
Meet the Experts: Marwah Abdalla, M.D., M.P.H., a cardiologist at New York-Presbyterian/Columbia University Irving Medical Center; Maya Feller, M.S., R.D., C.D.N., registered dietitian nutritionist; Melissa Prest, D.C.N., R.D.N., national media spokesperson for the Academy of Nutrition and Dietetics and member of the Prevention Medical Review Board.
Your diet plays a crucial role in your blood pressure and the foods you eat can either lower or raise your numbers, explains Melissa Prest, D.C.N., R.D.N., national media spokesperson for the Academy of Nutrition and Dietetics and member of the Prevention Medical Review Board. "Diets high in salt are known to potentially cause increases in blood pressure, while diets rich in fruits and vegetables tend to be associated with lowering blood pressure," she notes.
Along with lifestyle changes like lowering alcohol use, stress-relieving activities, and intentional movement, following the DASH diet or a similar diet can help manage blood pressure in just three months, says Maya Feller, M.S., R.D., C.D.N., registered dietitian nutritionist. That said, incorporating the below expert-approved foods into your diet, coupled with taking prescribed medication and following a regular exercise routine, can help lower your blood pressure.
Foods that lower blood pressure Low-fat or fat-free yogurtLow-fat dairy products are a great source of calcium, which is one of the main compounds that help combat high blood pressure. Feller adds that potassium, protein, vitamins, and minerals from yogurt complement your diet as well. A 12-ounce serving of low-fat yogurt will give you about 30%t of the recommended amount of calcium for the day.
Try it: For a burst of morning energy, mix a cup of low-fat Greek yogurt with granola, almond slivers, and berries for an extra heart-healthy boost. Not sure which brand to buy at the store? Check out our list of the best yogurt brands to help you make a healthier choice!
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BananasBananas are rich in potassium, with one average-sized banana packing about 420 milligrams of the nutrient. That's about 9% of the recommended daily intake. Prest notes that potassium is great for blood pressure management and research has shown diets low in potassium are associated with higher blood pressure. Bananas are also rich in fiber and lend a natural sweetness to smoothies, baked goods, and frozen treats. Peel and freeze mushy bananas when they start to go bad.
Try it: Try them sliced with your breakfast, like these Peanut Butter-Banana Pancakes
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BerriesBerries, but specifically blueberries, are packed with nitric oxide, a gas that helps increase blood flow, thus lowering blood pressure. A 2015 study by the Academy of Nutrition and Dietetics found that even less than an ounce of blueberries a day can help significantly lower blood pressure.
Try it: Add blueberries and other berries to your morning oatmeal and salads for lunch, or make them your dessert after dinner. And for a bowl as healthy as it is pretty to look at, dive into this decadent Spiced Blueberry Smoothie Bowl.
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Leafy greensLeafy greens like kale, spinach, collard greens, arugula, Swiss chard, beet greens, and romaine lettuce are excellent sources of potassium and magnesium. These work together to regulate blood pressure, says Dr. Abdalla. Think outside of the salad and glorify your greens in omelets, smoothies, and sandwiches.
Try it: If you want to sneak greens into a flavorful meal, try this Roasted Chicken and Potatoes With Kale.
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BeetsSimilar to blueberries, beets are high in blood pressure-reducing nitric oxide. Research has shown that drinking beetroot juice can help lower your systolic blood pressure by four to five mmHg. Try adding beetroot juice to your diet, and if you buy store-bought juice, make sure there isn't added sugar.
Try it: Enjoy beets in a salad (like this Swiss Chard and Beets Salad), soup, or slaw.
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GarlicAccording to the National Institute of Health (NIH), the compound allicin in garlic may be able to help reduce blood pressure. Allicin is released when garlic is crushed or chopped. However, doctors don't recommend using garlic supplements since there is limited research on their effectiveness for hypertension.
Try it: Make your own garlic spread by sprinkling olive oil on a full head of garlic, and then baking it in the oven until it's brown and soft. Cut off the top layer of the garlic head to produce a creamy and buttery texture.
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Sweet potatoesPotassium- and magnesium-rich sweet potatoes are an essential part of following a blood pressure-reducing diet. Sweet potatoes are also high in fiber, which is good for your heart, too.
Try it: Bake sweet potatoes in a sheet pan with your choice of lean protein for a quick and easy weeknight dinner. You can also make sweet potatoes the star with this Sweet Potato With Shredded Salad.
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OatmealHigh-fiber whole grains, especially oatmeal, have been linked to lowering the risk of cardiovascular disease, can help with weight loss, and may help to lower your cholesterol. Studies have shown that just three servings of whole grains a day can decrease your risk of heart disease by 15%t. Oatmeal for breakfast is a great way to start your day with whole grains. Add whole-wheat bread at lunch and quinoa, barley, or brown rice at dinner.
Try it: These Citrus-Spiced Overnight Oats may just be the easiest make-ahead breakfast, ever.
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SalmonFatty fish like salmon and mackerel are high in omega-3 fatty acids, which reduce inflammation and can help lower blood pressure, per the American Heart Association. They are also a great source of vitamin D, which helps the body absorb calcium, protect against depression, and regulate blood pressure.
Try it: Cooking fatty fish is super easy. Simply season it with salt, pepper, and herbs, add a little olive oil, and pop it in the oven to broil. For a specific recipe, try one of our best salmon recipes.
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AvocadoCreamy avocado is a great source of calcium, magnesium, and potassium—all of which help to bring your blood pressure numbers down. One avocado contains about 975 milligrams of potassium, which is about 25% of your daily intake.
Try it: Enjoy this unique take on avocado toast or add avocado to a salad like this Salmon Salad with Green Goddess Dressing.
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QuinoaThere is a reason quinoa is a super grain: A half-cup contains almost 15% of the magnesium you need in a day. Plus, it's rich in plant-based protein and fiber to relieve constipation, stabilize blood sugar levels, and ward off hunger.
Try it: Add quinoa to your salads, turn it into a cold "cereal" for breakfast, bake it into these Berry-Quinoa Muffins, or use it as a base for veggie burgers.
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BroccoliCruciferous vegetables, like broccoli, are high in all of the four magic compounds that help lower blood pressure—calcium, potassium, magnesium, and vitamin C. Studies have also shown that diets high in cruciferous vegetables have led to lower levels of heart disease and increased longevity.
Try it: Top your favorite flatbread like this Broccoli and Red Onion Flatbread or make a super simple Pan-Fried Chicken with Lemony Roasted Broccoli. Then, be sure to use the stalks in this Charred-Broccoli Relish.
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Peaches and nectarinesPeaches and nectarines are like fruit cousins that share a lot of similar benefits, one of which is their high potassium content. A large peach or nectarine provides about 10% of a person's daily recommended value. Potassium helps balance water levels in the body and helps us get rid of excess sodium, which helps lower blood pressure.
Try it: Eat these sweet fruits as a snack like this Nectarine Bruschetta, blend them into smoothies, add them to salads, or grill them to caramelize their sweetness, like these Peaches with Honey and Pistachios.
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KiwiThree kiwifruits a day have been shown to significantly lower blood pressure, according to a study by Oslo University Hospital. Of course, there is no magic fruit or vegetable that will rid you of your blood pressure problems, but adding more kiwi into your diet may be a step in the right direction.
Try it: Chop some kiwi up and sprinkle them over a yogurt parfait, or try blending it in a Green Kiwi Smoothie.
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Red bell peppersRed bell peppers help reduce high blood pressure with their richness of potassium and vitamin A. They're also high in fiber and vitamin C, making them a healthy snack to pair with your favorite dip or hummus.
Try it: If your peppers going bad in the fridge, blend them into a Roasted Red Pepper Dip, broil them with some olive oil, or add them to scrambled eggs or a frittata.
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Unsalted pumpkin seedsPumpkin seeds are rich in blood pressure-lowering magnesium and zinc. Pumpkin seed oil is also a good way to get the seeds' benefits. Be warned: Store-bought pumpkin seeds are usually high in added salt, so choose the unsalted varieties or roast your own by baking them in a sheet pan for 20 minutes at 350 degrees.
Try it: This Sauteed Butternut Squash, Kale, and Pumpkin Seed Penne is a delicious, quick dinner that can help your numbers go down.
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Dark chocolateGood news for all chocolate lovers: According to a 2017 study, flavonol-rich dark chocolate has been linked to a lowered risk of cardiovascular disease. The study found that the flavonols in dark chocolate helped promote healthy blood vessel function.
Try it: Just enjoy it! Remember to stick to a 1-ounce serving, as it can be calorie-dense if you go overboard.
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PistachiosPistachios have been proven to lower blood pressure by reducing blood vessel tightening and heart rate.
Try it: Add pistachios to a salad or breakfast cereal, blend it into a delicious Rigatoni with Pistachio Pesto, or bake it onto Pistachio-Crusted Fish and Spinach Quinoa. Just be sure to look for unsalted options at the supermarket.
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PomegranatesIt's not always easy to eat a pomegranate, especially since they're so hard to peel, but pomegranate juice is easy to drink and will give you the same benefits. A 2012 study in Plant Foods for Human Nutrition suggests that the high antioxidant levels in pomegranate juice can help lower blood pressure.
Try it: Add the juicy seeds to your favorite dishes, like this Cinnamon-Spiked Rice. When you're buying pomegranate juice, look for options that have no sugar added when available.
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Olive oilOlive oil may be high in calories, but it has many health benefits. Using polyphenol-rich olive oil has been linked to lowering blood pressure—especially among women. Make olive oil your go-to oil when cooking and research says replacing butter with olive oil may reduce your risk of disease and death. Plus, studies have also shown that consuming more olive oil could lower your risk of dementia-related death.
Try it: Use olive oil for dressings, frying, and baking in place of other cooking oils and butter when possible.
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Foods that raise high blood pressureThere are several foods that can particularly raise your blood pressure. According to the American Heart Association (AHA), you should limit these foods when trying to bring your numbers down:
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How to lower your blood pressure aside from dietAside from your diet, there are several lifestyle changes you can make to help lower your blood pressure. Per the AHA, this is what you can do to supplement your dietary efforts:
Enjoy regular physical activity
Manage stress
Reach and maintain a healthy weight
Quit smoking. Or don't start.
Take your medications properly
Work with your healthcare provider to make a plan that's right for you
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