when blood pressure goes up and down

One of the mysteries of blood pressure is that it can rise or fall without any obvious changes in your life. As you grow older, the systolic pressure (the top number) in particular tends to increase.

We used to believe that only the diastolic pressure (the bottom number) was important to control. But we now know that both numbers are important. Today, we recommend that most people over age 50 focus on the systolic reading as a guide to controlling blood pressure.

A variety of conditions can cause sudden changes in blood pressure. Some of the most common include chronic kidney disease, an overactive or underactive thyroid gland, and overactive adrenal glands. Talk with your doctor about these so-called secondary causes of hypertension to see if you should have additional tests. She will probably want to do some simple blood tests to check for them.

No matter what the cause, your systolic blood pressure is too high. It should be under 140, and I like to see it at 130 or below. Although most drugs affect both the systolic and diastolic pressure, some do have different effects on systolic and diastolic pressures.

Work with your doctor to develop a new program that reduces your systolic blood pressure. This will almost certainly include eating a healthy diet loaded with vegetables, reducing salt intake, keeping your weight in a healthy range, and getting more exercise.

You didn’t mention taking a thiazide diuretic, such as chlorthalidone. Unless a diuretic causes problems for you, it makes sense for a low dose diuretic to be part of your blood pressure medications.

Finally, it’s important to recognize that blood pressure fluctuates and that it can be difficult to measure accurately. Any time you check your blood pressure, make sure you haven’t had coffee or smoked in the 30 minutes before the reading, that you’ve been sitting quietly for at least 5 minutes, and that two measurements are made at least 2 minutes apart.