Understanding Blood Pressure: What the Numbers Mean and When to Worry
Blood pressure is the single most important modifiable risk factor for stroke and heart attack in Nepal. Over 30% of Nepali adults have hypertension, and the majority are either undiagnosed or inadequately treated. Understanding your blood pressure reading — what the numbers mean, when they are dangerous, and how to monitor correctly — is essential healthcare knowledge for every adult in Pokhara.
What Do the Two Numbers in a Blood Pressure Reading Mean?
Blood pressure is recorded as two numbers: systolic over diastolic, for example 120/80 mmHg. The systolic pressure (top number) is the pressure in your arteries when the heart contracts and pumps blood. The diastolic pressure (bottom number) is the pressure between heartbeats when the heart is relaxed and filling.
Both numbers matter. Isolated systolic hypertension — a high top number with normal bottom number — is the most common pattern in older adults and carries significant cardiovascular risk.
What Are the Blood Pressure Categories?
The following classification is based on the American College of Cardiology/American Heart Association 2017 guidelines, which are the current standard used in Nepal’s tertiary hospitals:
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|---|---|
| Normal | Less than 120 | Less than 80 |
| Elevated | 120–129 | Less than 80 |
| Stage 1 Hypertension | 130–139 | 80–89 |
| Stage 2 Hypertension | 140 or above | 90 or above |
| Hypertensive Crisis | 180 or above | 120 or above |
Note: Some Nepali clinicians still use the older JNC 7 criteria (hypertension defined as 140/90 and above). At A&B, management decisions follow the individual patient’s risk profile rather than the specific classification system used.
A hypertensive crisis (BP 180/120 or above) requires emergency evaluation, especially if accompanied by chest pain, headache, visual changes, shortness of breath, or neurological symptoms — these indicate hypertensive emergency with end-organ damage.
What Is White Coat Hypertension?
White coat hypertension refers to elevated BP readings in a clinical setting that normalise when measured at home or in relaxed conditions. It affects approximately 15–30% of patients diagnosed with hypertension in clinic settings. While it was historically considered benign, recent evidence shows that white coat hypertension carries a higher long-term cardiovascular risk than true normal blood pressure.
If your BP is consistently high at the clinic but you feel well and have no symptoms, your doctor may recommend home blood pressure monitoring or ambulatory blood pressure monitoring (ABPM) to distinguish genuine hypertension from white coat effect.
How Do You Monitor Blood Pressure Correctly at Home?
Home blood pressure monitoring is recommended for confirming hypertension, monitoring treatment response, and detecting white coat hypertension. Incorrect technique produces unreliable readings:
Equipment: Use a validated upper arm digital sphygmomanometer. Wrist devices are less accurate.
Timing: Measure twice daily — morning (before medications, before breakfast) and evening (before dinner). Record both readings.
Technique:
- Sit quietly for five minutes before measuring.
- Sit in a chair with back support; feet flat on the floor (no crossing of legs).
- Support your arm at heart level on a table.
- Place the cuff on bare skin, two finger-widths above the elbow.
- Do not talk during the measurement.
- Take two readings one minute apart; record both.
Avoid: Coffee, smoking, and exercise for thirty minutes before measurement. Do not measure during pain, anxiety, or immediately after physical activity.
A home blood pressure reading is considered normal if it averages below 135/85 mmHg over seven days of measurements. Above 135/85 at home is equivalent to clinic hypertension (above 140/90).
Why Is a Single Blood Pressure Reading Not Enough?
Blood pressure fluctuates throughout the day — higher in the morning, lower in the afternoon, lowest during sleep. A single clinic reading is influenced by stress, recent physical activity, caffeine, the time of day, and arm position. A diagnosis of hypertension should always be based on:
- At least two elevated readings on two separate occasions, or
- One elevated reading confirmed by home monitoring over 7 days, or
- ABPM demonstrating sustained elevation over 24 hours
The only exception is hypertensive emergency (BP above 180/120 with symptoms) — this requires immediate treatment regardless of prior readings.
What Are the Red Flags for Secondary Hypertension?
Most hypertension (90–95%) is essential (primary) — meaning no single identifiable cause. However, secondary hypertension — caused by an underlying disease — should be suspected in the following circumstances:
- Young patient (under 35) with significant hypertension and no family history or obesity
- Sudden onset or rapid worsening of previously controlled hypertension
- Resistant hypertension: BP remains above target despite three antihypertensive drugs at optimal doses (including a diuretic)
- Hypokalaemia (low potassium) with hypertension — suggests hyperaldosteronism
- Renal bruits on examination — suggests renovascular hypertension
- Palpitations, sweating, and headache episodes — suggests phaeochromocytoma
These patients require specialist investigation beyond primary care management.
What Is the Target Blood Pressure by Condition?
BP targets are personalised based on age and comorbidities:
| Patient Group | Target BP |
|---|---|
| General healthy adults | Below 130/80 mmHg |
| Adults with diabetes | Below 130/80 mmHg |
| Adults with CKD (without protein in urine) | Below 130/80 mmHg |
| Adults with CKD (with significant proteinuria) | Below 125/75 mmHg |
| Adults over 65 | Below 130/80 mmHg (if tolerated) |
| Elderly with frailty or falls risk | Below 150/90 mmHg |
Lower is not always better in elderly patients — excessively low BP can cause falls, dizziness, and acute kidney injury.
What Is Ambulatory Blood Pressure Monitoring (ABPM)?
ABPM involves wearing a BP cuff connected to a small recording device for 24 hours during normal daily activities. The device measures BP every 15–30 minutes throughout the day and night, producing a detailed 24-hour profile. ABPM is the gold standard for diagnosing hypertension, detecting white coat hypertension, and identifying nocturnal hypertension (which carries high cardiac risk).
ABPM is available on referral from A&B where clinically indicated.
Blood Pressure Check at A&B International Hospital
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Blood pressure measurement is available at every OPD visit. Full hypertension workup including ECG, renal function, and urine protein available. ECHS beneficiaries receive cashless investigations. If your blood pressure is above 180/120 with symptoms, come to the emergency department immediately — 24/7 emergency care is available.
