I went to my doctor yesterday for a sinus infection, and as usual, when my BP was taken, it was high -- 130/90. I got home, and it went back to high-normal (for me) of 124/84, and then an hour later back to my usual normal of 110/78. I know, good numbers -- but should I be concerned over how high it climbed at the doctor's office? Is it normal for such a difference (almost 20 points on both systolic and diastolic!) only an hour later?

Also, within the past 3 weeks, I've noticed changes in my readings. My systolic averages between 98-104, and my diastolic is between 75-80. I could've sworn I read somewhere that the larger the span between the systolic and diastolic, the stronger the heart. Is that correct? Is the small span between numbers indicative of a larger problem? Also, I've heard that doctors are now focusing on the systolic as the more important number -- is that true, too, and if so, why?

I take my BP 2X a day -- in the AM after waking and in the PM upon returning home from work. I'm sorry for the many questions, and thanks for your responses!

I can answer a couple for you. The higher reading at the doctors office sounds like white coat hypertension. Just being there makes it go up. You have good readings otherwise. Yes, blood pressure can change 20 points in one hour. In fact there can be a big change in only 5 minutes.

As for the span between the 2 numbers I have read that if there a difference of 60 or more points on a regular basis it indicates heart disease. Your numbers sound good.

It is true that doctors are now focusing on the systolic as the more important number but I don't know the reason. I am sure someone on this board can answer that.

The difference between the systolic and diastolic numbers is known as the "pulse pressure". Do a search in your favourite search engine and it'll throw up some interesting sites.

As rick mentioned, a pulse pressure of 60 or more may indicate some arterial stiffness which is an indication of potentially blocked blood vessels. Normal pulse pressure is 40. Having too low a pulse pressure is also not very desirable as it also may be indicative of other problems (I have sometimes gotten readings of 103/78, sometimes 99/75!).

Hi Amarra-
Okay here's the lowdown regarding systolic vs diastolic and pulse pressure (span between the two).
Just like you, most of us, when told we have high blood pressure, usually want to know what sort of health risks we face, and how serious it is. Which number is more important? The upper (systolic) or the lower (diastolic) measurement? Or is the difference between the two numbers (the pulse pressure, or PP) or the average of the two (the mean arterial pressure, or MAP) more important in predicting the risk of heart attack, etc?


Harvard scientists used the results of two large clinical studies to analyze the usefulness of different blood pressure readings for determining the likelihood of a cardiovascular event (such as heart attack, a stroke, sudden heart death, or the need for a coronary bypass or angioplasty).
The trials were the Physicians' Health Study (22,000 men followed for 13 years) and the Women's Health Study (40,000 women followed for 6 years).

Separate analyses were done for the men and women.


The known risk factors for cardiovascular disease (diabetes, smoking, overweight, and so on) were present equally in both the men and women participants, except for a higher level of exercise and alcohol intake in the men, and a slightly higher body mass index (BMI, a measure of overweight) in the women.
In both men and women, overall lower levels of blood pressure predicted lower rates of cardiovascular events, without an obvious plateau - that is to say, a point where lowering the blood pressure further didn't improve the risk.
In men, benefits were seen with the lowering of both systolic and diastolic blood pressure values, and the effect of lower diastolic levels were less clear.
In women, lowering of systolic BP was associated with the reduction in risk.

These findings suggest that the systolic is more important than the diastolic pressure for predicting cardiovascular problems in both men and women, and that interestingly, it's even more important in women.


Further analyses showed that the pulse pressure (PP) (the difference between the two #s you asked about) was about as useful as the diastolic pressure. Which is to say, not as great a predictor of future problems, as your systolic #s are.

Bottom line, there's no clear advantage to making these additional calculations.

You're #s are great! In your case, I would not worry about the pulse pressure.

zuzu xxx

P.S. Wr6969- We both posted simultaneously. Didn't mean to ignore your post! You're right that a PP of 60 or more might be an indication of arterial stiffness, but basically hypertension per se is, in and of itself, an indication of arterial stiffness, no? The studies I cited though, do say that attention must be paid to the systolic as a greater "predictor" of future problems, more than PP and diastolic #s. And that the PP is even less important a # than even the diastolic.

zuzu xxx

Hi zuzu, no problems! Glad you provided a much more thorough explanation than I did!

I would guess the bottom line is that these "numbers" or indicators will be taken into consideration by your respective doctors/cardiologists when they attempt to do a detailed diagnosis of your problems. You're right - in and of itself, numbers by themselves don't mean anything much :)

And isn't it surprising (shocking?) the sways in medical opinions as time goes on? We used to be reminded how important diastolic numbers were (I for one was certainly worrying my wits off about my isolated diastolic hypertension!) and now there's a complete U-turn about it. However, I do recall reading somewhere that the systolic pressure is more important the older you get; at a relatively young age, the diastolic numbers are important too. Nonetheless, as you've implied, whenever either number is elevated, it is a cause for concern and should be investigated and remedied.

WOW -- thanks so much for the detailed response! This board has been so much more helpful and informative than my doctors -- when I ask these questions, I'm often met with "that's not a concern you have to worry about", or no explanation whatsoever. And they wonder why I have "health anxiety"!!!

THANK YOU for your very quick and thorough responses. You've calmed my fears considerably!

I've always thought of the difference between systolic and diastolic as a good measure of arterial stiffness...more often than not, plaque and calcium deposition in the arterial walls. I like the term PULSE PRESSURE as the difference between the two.

Though indeed, all HBP indicates some degree of stiffness, the HBP of water retention (i.e. RENIN mediated edema, reaction to excess sodium, failing kidneys etc.) might well behave quite differently from the HBP of "hard arteries" and would likely raise BOTH the diastolic and systolic...thus not increasing the "pulse pressure" nearly so much as arterial disease would.