Abstract

“Doc, I know you said my blood pressure was normal at 132/86 but it has always been a lot lower. What does this mean?”

How often have we heard this from a middle-aged female patient? On one hand we might reassure her that normal is normal, but on the other hand we can’t help thinking that she has a point. Clinical trials and guidelines to date have appropriately focused on the consequences and therapy of frank hypertension. Many of these studies, although excellent, do not take into account gender, ethnicity, different patterns of normal blood pressures, and the varying transition to hypertension women make during their peri- and postmenopausal years. Indeed, highly regarded expert consensus statements vary with the American Joint National Committee 7 which categorizes systolic blood pressures of 120 to 139 mm Hg and diastolics of 80 to 89 mm Hg as “prehypertensive.” The European guidelines, however, differentiate between 120 to 129/80 to 84 mm Hg as “normal” and 130 to 139/85 to 89 mm Hg as “high normal” (with above 140/90 hypertensive and below 120/79 optimal). With a prospective randomized study being unlikely to be done because of difficulties of cost, design, and time, well-done large, cohort, or retrospective studies are currently our best hopes of addressing the challenge of rising blood pressures within the putative normal range in our middle-aged woman patients.