What blood pressure goal should I aim for?

Q. Hi Dr. Tam. I'm a 61 year old woman and was recently told by my doctor that my blood pressure was high ("145/88"). I'm confused, as some sources say that is normal, and others say I need to be on medicine. Which is right??

A. In the current medical climate, trying to figure out blood pressure goals is enough to raise your blood pressure!  The reason we care so much about high blood pressure, or 'hypertension' is that it can lead to heart attacks, stroke, and death. Yet how high is "high" has yet to be answered definitively.  In 2013, the Eight Joint National Committee released updated guidelines for physicians (http://jama.jamanetwork.com/article.aspx?articleid=1791497). According to these guidelines individuals > 60 years old (and without diabetes or kidney disease) should have a target blood pressure of < 150/90. So therefore, your blood pressure would be considered at goal. BUT.... stay tuned, as a recent study by the National Heart Lung and Blood Institute of almost 10,000 patients with high blood pressure over the age of 50 showed that aggressive lowering of blood pressure below 120 actually resulted in a 30% decrease in cardiovascular events (https://clinicaltrials.gov/ct2/show/NCT01206062?term=Systolic+Blood+Pressure+Intervention+Trial&rank=1). So the jury is still out on this one. Best to discuss with your physician to determine benefits/ risks of starting medication.

In the meantime, ensure that your blood pressure was confirmed at least twice in the office before starting any medications.  In addition, lifestyle changes such as a healthy diet, exercise, and avoiding tobacco can usually be tried prior to medication if deemed acceptable by your physician. Good luck!