When to Discuss Blood Pressure Readings With a Doctor

Home monitoring produces numbers, and numbers raise questions. Is this reading too high? Should I call someone, or wait? Most readings need no urgent action, but some do. This guide sets out which readings to raise with your doctor and how quickly.

Start with what is normal

The American Heart Association classifies adult blood pressure as:

• Normal: below 120 and below 80
• Elevated: 120 to 129 and below 80
• High blood pressure, stage 1: 130 to 139 or 80 to 89
• High blood pressure, stage 2: 140 or higher or 90 or higher

A single reading does not establish a category. Blood pressure varies, so doctors rely on averages from several days.

Mention at your next routine visit

• Elevated readings (120 to 129 systolic with diastolic below 80). Lifestyle measures are usually recommended to prevent progression.
• A gradual upward trend over months, even if still in the normal range.
• Readings that differ noticeably from clinic measurements.
• A consistent difference between arms.
• The irregular heartbeat symbol appearing now and then.

Bring your written record and, if possible, your monitor.

Make an appointment soon

• Your average over a week is 130/80 mm Hg or higher and you have not been diagnosed with high blood pressure.
• You are on treatment and your readings are above the target your doctor set.
• Your readings have risen suddenly compared with your usual levels.
• The irregular heartbeat symbol appears frequently, or your pulse feels irregular.
• You have side effects you think are caused by blood pressure medicine, such as dizziness, a persistent cough or swollen ankles. Do not stop the medicine without advice.
• Low readings with symptoms: light-headedness, fainting, blurred vision or unusual tiredness, particularly after starting or changing a medicine.

Call your healthcare professional immediately

If your blood pressure is higher than 180 systolic or higher than 120 diastolic:

1. Stay calm and sit quietly for a few minutes.
2. Measure again.
3. If the second reading is still that high and you have no other symptoms, contact your healthcare professional immediately. They may adjust your treatment or ask to see you.

Call 911

A reading higher than 180/120 mm Hg together with any of the following may indicate organ damage and is an emergency:

• chest pain;
• shortness of breath;
• back pain;
• numbness or weakness;
• change in vision;
• difficulty speaking.

Do not wait to see whether the pressure comes down.

Also call 911, whatever your reading, for signs of a heart attack, such as chest pressure or pain spreading to the arm, jaw or back, or of a stroke, such as sudden drooping of the face, arm weakness or slurred speech.

Special situations

Pregnancy

High blood pressure in pregnancy needs prompt assessment. If you are pregnant or have recently given birth, report raised readings to your maternity team without delay, and seek urgent care for severe headache, visual disturbance, pain below the ribs, or sudden swelling of the face, hands or feet.

Diabetes, kidney disease or heart disease

Targets may be set individually. Ask your doctor what yours is and at what level to call.

Older adults

Dizziness on standing may indicate a drop in blood pressure. Mention it, since treatment may need adjusting.

Before you call or visit

Have ready:

• your recent readings with dates and times;
• a list of your medicines and any missed doses;
• your symptoms and when they began;
• anything that might explain the reading, such as pain, stress, caffeine or a decongestant medicine.

Check your technique first

Many alarming readings are caused by measurement error. Before concluding that your blood pressure is high, confirm that you:

• rested for five minutes;
• sat with back supported, feet flat and arm at chest height;
• used the right cuff size on a bare arm;
• did not talk.

Then repeat the reading.

Do not adjust treatment yourself

Never stop, start or change the dose of a medicine on the basis of home readings unless your doctor has given you a specific plan.

How often should blood pressure be checked?

If your blood pressure is normal, ask your doctor how often to recheck it. People with high blood pressure usually follow a home schedule agreed with their team. A record such as our Blood Pressure Log Book keeps the readings your doctor needs in one place.

The bottom line

Share consistent readings at or above 130/80, act at once on readings above 180/120 that persist, and call 911 if symptoms accompany them. When in doubt, ask. Find monitors and log books in our heart and blood pressure range.

Sources

1. American Heart Association. Understanding Blood Pressure Readings.
2. National Heart, Lung, and Blood Institute. High Blood Pressure.
3. NHS. High blood pressure.
4. Centers for Disease Control and Prevention. About High Blood Pressure.