Image: Blood pressure cuff
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The concept of "normal" blood pressure is one of the major misconceptions many people have about hypertension.
updated 12/14/2008 11:35:27 AM ET 2008-12-14T16:35:27

The other day, I measured a new patient's blood pressure, which was 120/80, and told her I wanted to get those numbers down more. "But Doctor," she protested, "why should they be lower? They're perfectly normal!"

I explained to her that, yes, national guidelines set "normal" blood pressure at 120/80, but I consider that standard to be arbitrary. I believe your target blood pressure level can be determined only within the context of your other cardiovascular risk factors. For instance, my patient has diabetes and high cholesterol and is overweight, so I'd like to see her blood pressure at 110/70 or even lower.

The concept of "normal" blood pressure is one of the major misconceptions many people have about hypertension. If you're among the 73 million Americans who have high blood pressure, here are a few others you should know about:

Myth: Cholesterol matters more than blood pressure.
The reverse more often is true. If you have high cholesterol but your ratio of HDL ("good) to LDL ("bad") is healthy, or if your cholesterol particles tend to be large, your risk of heart attack is not great. High blood pressure, however, is always putting stress on your blood vessels, including those supplying your heart with blood. This stress makes it easier for the bad LDL cholesterol particles to penetrate the inner lining of your vessel walls, where they accumulate and form plaque that eventually leads to heart attack and stroke.

Myth: If you have hypertension, you should measure your blood pressure every day.
Once a week is often enough. Although home measuring devices help patients manage their blood pressure, they can also encourage overuse. Damage occurs over years, not days or weeks. Keep track of your average blood pressure over many months, and give this information to your doctor whenever you go for a visit.

Myth: If you're hypertensive and feeling poorly, it's probably because your blood pressure is elevated.
This is almost never the case. Whatever is causing your symptoms is elevating your blood pressure, not the other way round. When you don't feel well or have pain, whether from a virus or a minor sprain, your body releases adrenaline, which causes your blood pressure to rise. If you don't feel well, don't take your blood pressure. You'll worry needlessly.

Myth: A bad headache could mean your high blood pressure is about to cause a stroke.
This widely held misconception dates to the time of President Franklin Roosevelt, who died in office in 1945 from a massive cerebral hemorrhage after reporting, "I have a terrific headache." Roosevelt, who was in poor health, had stratospheric blood pressure, in the range of 260/150. Among the many factors that contributed to his condition was the fact that none of today's safe, effective medications were available to him. Today, patients virtually never develop the changes in their hearts and blood vessels that ultimately killed Roosevelt. In 30 years of medical practice, I've never seen a patient receiving proper treatment suffer a hypertensive emergency like his.

In dispelling these myths, I don't mean to minimize the importance of being vigilant about monitoring your blood pressure. Just know that, as part of a regimen that includes a healthy lifestyle and medications when necessary, worry should play no part.

Arthur Agatston, MD, an associate professor of medicine at the University of Miami Miller School of Medicine, is the author of "The South Beach Diet Supercharged: Faster Weight Loss and Better Health for Life." He maintains a cardiology practice and research foundation in Miami Beach, FL.



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