Why Is My Bottom Blood Pressure Number High?

Isolated diastolic hypertension (IDH) occurs due to high diastolic blood pressure.

Blood pressure (BP) is the force of your blood pushing against the walls of your arteries, blood vessels that carry blood from the heart to the other parts of your body.

Your blood pressure can be measured using two numbers:

• Systolic (the top number): pressure exerted when the heart pumps blood throughout the body
• Diastolic (the bottom number): pressure exerted when the heart relaxes and refills with blood

Blood pressure consistently higher than 130/80 mm Hg is known as high blood pressure (hypertension). If your systolic blood pressure is normal but your diastolic pressure is higher than 80 mm Hg, then you have high diastolic blood pressure, also known as isolated diastolic hypertension.

What are the different blood pressure levels?

The blood pressure levels are usually given as numbers with the systolic over diastolic pressure. The table below shows different blood pressure levels and conditions.

What are the different blood pressure levels?

The table shows different blood pressure levels and conditions.

With hypertension, typically both systolic and diastolic blood pressures are elevated. However, isolated diastolic hypertension (IDH) occurs when your systolic blood pressure is normal, and only your diastolic blood pressure is high (over 80 mm Hg).

IDH is an uncommon type of hypertension, accounting for less than 20% of all hypertension cases. Like other types of hypertension, such as general or high systolic blood pressure, IDH can increase the risk of stroke, heart disease, heart attack, heart failure, aneurysm, atrial fibrillation, peripheral arterial disease, vision loss, and chronic kidney disease.

Possible causes of isolated diastolic hypertension include:

• High-sodium diet
• Obesity
• Lack of physical activity
• Excessive alcohol consumption
• Stress and anxiety
• Medications including:
  • Amphetamines
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Antidepressants
  • Oral contraceptive pills
  • Caffeine
  • Decongestants
  • Atypical antipsychotics
  • Steroids

Hypertension or high blood pressure (high BP) is a medical condition in which the pressure in the arteries is persistently elevated. The heart pumps blood into the arteries, and it is circulated to all parts of the body. Hypertension develops when the heart constantly needs to exert higher force to deliver blood to the organs through the arteries.

Since a hypertensive heart must work harder to deliver blood, hypertension can increase the risk of cardiovascular disease, heart attack, and heart failure. Also, the blood vessels in people with hypertension are narrower, putting them at risk of stroke, kidney disease, and vision loss.

There are many reasons for high blood pressure, such as:

• Caffeine
• Acute stress or anxiety
• Certain medications (such as nonsteroidal anti-inflammatory drugs)
• Combinations of medications
• Recreational drugs
• Sudden or acute pain
• Dehydration
• White coat effect (fear of being in a hospital or doctor's clinic)

Hypertension is generally considered a silent killer. Most people with high diastolic blood pressure or other types of hypertension do not have any symptoms.

It may take many years for the condition to become severe and for symptoms to appear. Often, these symptoms can be attributed to other issues. The best way to know your blood pressure levels is through regular checkups.

Symptoms of severe hypertension of all types, including high diastolic blood pressure include:

• Severe headaches
• Anxiety
• Nosebleeds
• Nervousness
• Sweating
• Fatigue or confusion
• Irregular heartbeat
• Facial flushing
• Dizziness
• Vision problems
• Chest pain
• Shortness of breath
• Sleeping problems
• Blood in the urine
• Black spots in the eyes
• Pounding in the chest, neck, or ears

There are two types of hypertension:

1. Primary or essential hypertension

Primary or essential hypertension is when hypertension has no identifiable cause (for example another disease or condition). It develops gradually over the years.

This type of hypertension may be the result of multiple factors, including:

• Blood plasma volume
• Hormone activity
• Genes
• Physical changes in the body due to age
• Environmental factors, such as stress and lack of exercise

2. Secondary hypertension

In some people, an underlying health condition is what causes high blood pressure. This type of hypertension tends to appear suddenly. Secondary hypertension also generally causes higher blood pressure than primary hypertension.

Secondary hypertension is caused by specific conditions and their complications including:

• Kidney disease
• Congenital heart defects
• Congenital defects in blood vessels
• Obstructive sleep apnea
• Certain endocrine tumors
• Adrenal gland tumors
• Cushing syndrome
• Congenital adrenal hyperplasia
• Thyroid problems
• Pregnancy
• Obesity
• Certain medications, such as birth control pills, cold remedies, decongestants, pain relievers, and some prescription drugs
• Use of illegal drugs, such as cocaine and amphetamines

Factors that increase the risk of hypertension include:

• Being over the age of 60, when arteries stiffen and narrow due to plaque buildup
• Being overweight or obese
• Regular tobacco use
• Alcohol abuse
• Male gender
• Sedentary lifestyle
• Lack of exercise
• High fat intake
• High salt intake
• Low potassium diet
• Stress
• Family history of hypertension
• Existing health conditions:
  • Cardiovascular disease
  • Diabetes
  • Chronic kidney disease
  • Sleep apnea
  • High cholesterol levels

Isolated high diastolic blood pressure can often be managed with lifestyle modifications, dietary supplements, and medications.

Lifestyle modifications

• Maintaining a healthy weight
• Eating a high-fiber diet rich in fruits and vegetables and low in saturated fat and dairy products
• Reducing sodium in the diet
• Exercising regularly
• Quitting smoking
• Limiting alcohol use
• Managing stress
• Getting adequate sleep
• Practicing slow, deep breathing
• Monitoring blood pressure at home

Dietary supplements

Dietary supplements that may help lower blood pressure include:

• Electrolyte minerals such as magnesium, calcium, and potassium
• Supplements that widen blood vessels, such as cocoa, coenzyme Q10, L-arginine, and garlic
• Omega-3 fatty acids found in fish oil supplements and flax seeds

Medications

If lifestyle and dietary changes are not enough to lower your blood pressure, your doctor may prescribe medications for you.

What is considered high diastolic blood pressure?

Diastolic blood pressure that is between 60-80 mm/hg is normal, and anything above 80 is considered high diastolic blood pressure. Diastolic pressure of 80 to 89 is hypertension stage I, 90 and higher is stage II, and diastolic pressure of 120 or above is a critical condition known as a hypertensive crisis that requires immediate medical attention.

What causes high diastolic blood pressure?

A sedentary lifestyle and resultant obesity, high-sodium diet, smoking, drinking, and use of recreational drugs are the primary causes of all types of hypertension, including high diastolic blood pressure. Chronic stress, certain medications, and health conditions such as diabetes, kidney disease, and hyperthyroidism are some of the other causes. Studies have found that IDH is more prevalent in men below 60 years, and people who are sedentary, smoke, drink alcohol, have a BMI higher than 28 kg/m2, and/or have diabetes or prior cardiovascular events.

Is high diastolic blood pressure dangerous?

High diastolic pressure is dangerous because it weakens the blood vessels, and increases the risk for coronary heart disease, stroke, aneurysms, and damage to several organs. There is relatively less awareness among people about the dangers of IDH than those of general or isolated systolic hypertension. A large study found that younger adults, particularly men, are more likely to have IDH, and most are unaware of it, and it may go untreated.

What are the symptoms of high diastolic blood pressure?

Very often, high diastolic blood pressure, like other types of hypertension, may not cause any symptoms until it gets severe, so it is essential to monitor your BP regularly and get it treated if it is consistently high. Severe hypertension, including IDH, can impact all organs in the body and cause various symptoms ranging from headaches, nosebleeds, and vision problems to chest pain, shortness of breath, and dizziness, as enumerated in the article.

How can I lower my diastolic blood pressure?

The following are some of the most important lifestyle factors that can help lower your diastolic blood pressure:

• Follow a balanced and heart-healthy diet, and avoid highly processed, salty, fatty, and sugary foods.
• Exercise regularly with a combination of aerobics and strength training.
• Maintain a healthy body weight.
• Avoid or limit alcohol, and refrain from smoking and use of recreational drugs.
• Manage stress with calming techniques and get sufficient sleep.
• Monitor your BP regularly, and if you are taking medications to control your BP do not miss your regular doses.

What is isolated diastolic hypertension?

When only the diastolic blood pressure is higher than normal and the systolic blood pressure remains normal, it is known as isolated diastolic hypertension (IDH). It is more often found in adults younger than 60. With older age, general hypertension, where both systolic and diastolic pressures are high, and occasionally, isolated systolic hypertension is more common. This is because diastolic pressure tends to reduce after the age of 50, when arteries become stiffer and narrower, and don't bounce back as they do at a younger age.

In 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) defined isolated diastolic blood pressure (IDH) in their guidelines as diastolic blood pressure (DBP) of 80 mm Hg and above, with systolic blood pressure (SBP) less than 130 mm Hg. However, the Joint National Committee 7 (JCN7) and 2018 European Society of Cardiology (ESC) guidelines define IDH as 90 mm Hg or higher DBP with SBP lower than 140 mm Hg.

What are the long-term effects of high diastolic blood pressure?

If untreated, chronic high diastolic blood pressure can increase the risk of cardiovascular and cerebrovascular diseases, and damage to many organs.

Some of the long-term effects include:

• Weakening of blood vessels, coronary artery disease, and aneurysm
• Heart conditions such as coronary heart disease, enlarged left ventricle (left ventricular hypertrophy), heart attack, and heart failure
• Transient ischemic attack (TIA), stroke, and decline in cognitive function
• Peripheral artery disease
• Chronic kidney disease
• Damage to the retina and vision impairment or loss

What foods should I avoid with high diastolic blood pressure?

If you have high diastolic blood pressure, avoid the following foods:

• Foods high in salt: Restaurant foods, frozen foods, packaged foods and snacks, ketchup and sauces, processed meats, and pickled foods tend to be high in salt. Limit consumption of these, and as far as possible, stick to home-cooked meals where you can control the salt content.
• Highly processed foods: These often are high in salt and trans-fats, which are used to preserve and enhance their taste.
• Fatty foods: These can increase plaque formation in the arteries, and further raise your blood pressure.
• Sugary foods: Sweets and sweetened drinks can increase your weight, and obesity is a direct contributor to high blood pressure. Eat fruits to satisfy your sweet tooth.
• Beverages: Avoid or limit beverages with caffeine, as well as alcohol.

When should I see a doctor for high diastolic blood pressure?

See your doctor if your diastolic blood pressure is consistently higher than normal, so you can receive appropriate treatment. Thereafter, you can monitor your blood pressure at home. If your diastolic pressure goes up to 120 or higher, systolic pressure to 180 or higher, or both go high, you should seek medical help without delay. It is known as a hypertensive crisis, a medical emergency that can damage your heart, brain, and kidneys, if not treated immediately.

What lifestyle changes can help lower diastolic blood pressure?

Maintaining a healthy weight by following a heart-healthy diet and a regular exercise regimen, avoiding alcohol consumption and use of tobacco and/or recreational drugs, and managing stress with activities like yoga or deep breathing can go a long way in keeping your diastolic blood pressure within the normal range.