High Diastolic Blood Pressure: When to Worry

You won’t have a single appointment with your doctor without them taking the time to measure your blood pressure. But do you know exactly what the two numbers displayed on their device mean? And in particular, the second one, the diastolic pressure? What are the causes of high or low diastolic pressure? What are the symptoms and how can you normalize this blood pressure? Furthermore, what constitutes normal diastolic pressure? Professor Alain Furber, cardiologist and president of the French Federation of Cardiology (FFC), explains.

What is diastolic blood pressure?
Blood pressure is the pressure with which blood circulates inside the arteries. This allows blood to reach absolutely every part of the body, from the scalp to the toes.

“The first phase of the cardiac cycle is when the heart contracts and blood is ejected; this is called systole,” explains Professor Furber. “This is the first number that appears on the blood pressure monitor.”

“In the second phase, the heart relaxes; this is diastole, the second number. This phase corresponds to the filling of the heart chambers with blood.”

Is it possible to have hypertension that is primarily diastolic (with a systolic blood pressure below 140 mmHg)? “Yes,” replies Professor Furber, “particularly in those under 65. After that, it tends to become more systolic. This is due to aging, which leads to a stiffening of the artery walls.”

A diet too high in salt;
sleep disorders;
being overweight or obese;
a lack of physical activity;
alcohol;
certain medications such as the contraceptive pill;
anti-inflammatory drugs or corticosteroids;
and the use of drugs such as cocaine or amphetamines.
More rarely, there may be underlying causes. For example, renal artery stenosis (a reduction in blood flow in one or both of the main renal arteries or their branches), or any disease that can lead to kidney failure.

In the absence of a known cause, it is referred to as essential hypertension, often with a genetic component (a history of early-onset hypertension in one’s father or mother).

How to lower diastolic blood pressure?
Diastolic blood pressure between 90 and 100
: “If diastolic blood pressure is between 90 and 100, it’s best to wait a while before considering any treatment. At this stage, dietary measures may be sufficient.”

Lose a few pounds if overweight;
reduce or even eliminate alcohol;
quit smoking;
adopt a healthier diet;
get at least 150 minutes of physical activity per week;
reduce salt intake. The WHO
advises
adults to consume less than 5 grams of salt per day.
Diastolic blood pressure above 100
: “When diastolic blood pressure is higher, above 100, treatment should be started more quickly. Generally, the doctor begins with monotherapy. In other words, they prescribe a single medication to the patient. A few weeks later, the patient returns for a follow-up appointment to assess the effectiveness of this medication. If it works, great. If not, the doctor may try a combination of several medications.”

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How is the diagnosis made?
“By simply measuring blood pressure in the doctor’s office. When the readings are above 140/90, it’s considered hypertension. But be aware, it will need to be confirmed with further measurements, because the white coat effect can raise blood pressure.”

Furthermore, blood pressure fluctuates throughout the day, during sleep, exercise, etc. Therefore, patients should take their own measurements at home with a device worn on the upper arm, not the wrist, as the latter lack accuracy. To take their blood pressure, simply purchase an automatic blood pressure monitor (no prescription is required) from a pharmacy and follow the rule of three. That is:

three measurements in the evening;
for three consecutive days.
“It is also possible to record your blood pressure for 24 hours using a cuff. This is called Ambulatory Blood Pressure Monitoring (ABPM), or 24-hour blood pressure monitoring.” This test allows you to monitor blood pressure variations throughout the day and to measure blood pressure while the patient sleeps. It must be worn continuously during this time. You should not shower, to avoid damaging it. Apart from this restriction, wearing this cuff is completely painless and does not interfere with normal activities.

“The patient suffers from diastolic hypertension above 90 mmHg (millimeters of mercury) when measured in the doctor’s office, and above 85 mmHg when measured by home monitoring or ABPM. This hypertension may be isolated, or associated with systolic hypertension.”

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