University Health System Blog

Dr. Kate Martin answers the question: “What’s the significance of the spread between systolic and diastolic blood pressure readings?”

Blood pressure is measured through systolic and diastolic readings. An example of a normal value is 120 mmHg and 80 mmHg, often said as 120 over 80 and written as 120/80.

The numerator, which is the systolic value, is the peak arterial pressure reached when the heart muscle contracts.

The diastolic pressure, the denominator, is the residual amount of pressure in the arteries when the heart muscle relaxes.

The difference between the systolic and diastolic pressures is known as the pulse pressure.

The average person has a resting pulse pressure of 40 mmHg. This can become transiently elevated with exercise due to increased demands on the heart and blood vessels but returns to normal about ten minutes afterwards.

Persistently high or low pulse pressure can have serious health implications, however.

Most often encountered in situations of trauma to the chest or abdomen, a low or narrow pulse pressure usually indicates there has been a significant amount of blood loss. Other situations that can also cause low pulse pressure include congestive heart failure and aortic stenosis, in which there is a narrowing of blood flow through one of the major heart valves. In these circumstances, pulse pressure is often as low as 25 mmHg.

A common cause of consistently elevated pulse pressure is stiffness of one of the major arteries, such as the aorta. This may be the result of fatty deposits along walls of the arteries, known as arteriosclerosis, or a leaky heart valve. Other conditions that may cause this include hyperthyroidism, anemia and abnormal connections of arteries with veins called arteriovenous malformations. In general, a pulse pressure greater than 60 mmHg is considered abnormally elevated or widened.

Recent research has indicated high pulse pressure is a risk factor for the development of heart disease and arrhythmias. Treating high blood pressure usually helps reduce pulse pressure as well.

Kate Martin, M.D. is an assistant professor of family and community medicine at the University of Nevada School of Medicine in Las Vegas. She practices at the Family Medicine Clinic.

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Dr. Thomas Hunt answers the question: “What is heart rehabilitation?”

According to the American Heart Association high blood pressure affects 70 million Americans—and more than one in three don’t even know they have it. If undiagnosed or untreated, hypertension can lead to the hardening of arteries, which can lead to heart attack, stroke, kidney failure and death. An internist or family physician can help you monitor your blood pressure and help you take the necessary steps to keep your blood pressure at a healthy level to prevent possible heart disease.

But for patients with heart disease, there may still be steps you can take to a healthier heart. Cardiac rehabilitation is a medically supervised program to help patients with heart conditions recover following a heart attack or heart surgery. It’s generally divided into phases that include monitored exercise, nutrition counseling, emotional support and education on lifestyle changes.

A heart rehabilitation program generally begins while the patient is hospitalized and continues after the patient goes home. It’s a customized program that can significantly increase one’s chances of survival following a heart attack. Today through improved programs and close monitoring, cardiac rehabilitation is an option for people of all ages and patients with many types of heart conditions including coronary artery disease, peripheral arterial disease and angina, or who have undergone procedures like a cardiomyopathy, coronary bypass surgery or heart transplant.

Although more patients are able to participate and benefit from cardiac rehab, it’s not appropriate for everyone. A patient needs to undergo a doctor’s thorough evaluation to find out if a patient is a good candidate for heart rehab.

Components of heart rehabilitation

Medical evaluation
Both initial and ongoing medical evaluations allow your doctor to assess physical abilities, medical limitations and other conditions you may have. Your doctor will explore your risk factors for cardiovascular disease, stroke or high blood pressure and use these findings to personalize cardiac rehab for you.

Physical activity
Exercise is a critical component of rehabilitation therapy. No longer is bed rest necessarily recommended if you have a serious heart condition. Exercise improves one’s cardiovascular fitness and can include walking, cycling, rowing or jogging. Strength training is also usually part of the program. If you’ve never exercised, your doctor will design a program that moves at a safe, comfortable pace.

Lifestyle changes
Changes in your lifestyle is an important component of the rehabilitation process. Guidance on diet and nutrition will help you shed extra weight and teach you to make healthier food decisions that reduce the intake of fats, salt and cholesterol. You will receive support on beating unhealthy habits such as smoking or consumption of excess alcohol. You will also learn how to manage the pain or fatigue that may accompany your heart condition. Current AHA guidelines advise on getting cholesterol levels to a healthy level as part of cardiac rehabilitation—reducing your low density lipoprotein, or bad cholesterol, less than 100 milligrams and ideally under 70 milligrams is an important goal.

To learn more about controlling your high blood pressure and heart health, speak to an internist at our Patient Care Center in Las Vegas or Internal Medicine and Multispecialty Clinic in Reno or a family doctor at our Family Medicine Clinic in Las Vegas or Family Medicine Center in Reno.

Thomas Hunt, M.D. is an associate professor in the Department of Family and Community Medicine at the University of Nevada School of Medicine in Las Vegas.

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