The Ideal Blood Pressure, According to Science

The ideal blood pressure is not 120/80.

It could be as low as 95/60.

And it all depends on you.

OUR NATURAL—PREHISTORIC—BLOOD PRESSURE

Too bad that fossils can’t tell us much about a person’s blood pressure.

Even the well-preserved body of Otzi, “The Iceman”, doesn’t exactly reveal what his blood pressure was thousands of years ago. Before civilization started to wreak havoc on our health.

Luckily, there are still tribes on this planet that live much like our prehistoric ancestors. They provide some important clues to our species’ ideal blood pressure.

Time and time again, research has shown that their blood pressure stays at about 95–120/61–80 mm Hg throughout their lifetime.

These findings stay true so long as these tribesmen and women don’t adopt “civilized” customs and continue to live their “natural” lifestyle instead.

It stays true even as they age and irrespective of the fact that many of them partake in some unhealthy activities of their own. This includes a diet rich in dreaded salt.

What are we to make of that? Is 95/61 mm Hg the ideal blood pressure of mankind, then?

Relying on the measurements of a few tribespeople and calling it a day would be too easy; and rightfully disputed by a few.

Perhaps other scientific evidence has something to say about this…

HUMANS VS. NATURE

U.S. medical organizations define normal blood pressure as anything that is less than 120/80 mm Hg (millimeters of mercury).

In other words, less than 120 mm Hg (systolic blood pressure – “the top number”) and less than 80 mm Hg (diastolic blood pressure – “the bottom number”).

This is how we have categorized “normal”, not necessarily ideal, blood pressure—for now.

And therein lies part of the problem.

We love to categorize anything we can, like a person’s race, even if arbitrarily so.

But if you doubt that the categorization of blood pressure is arbitrary, then consider this.

In 2017, several highly respected medical organizations classified blood pressure. In terms of what is normal, what should be treated, and so forth.

These organizations used the same exact body of scientific evidence to come to their conclusions just a few months apart.

Did they agree with one another?

No.

They couldn’t agree on the cutoff values of some pretty important categories.

But this—potentially very costly—classification debate can be left to those organizations for this article’s sake.

Beyond logical limits (like 0 mm Hg), nature has no classification scheme for blood pressure.

That’s because blood pressure is not a category. It’s not black or white.

Instead, blood pressure—and the risks associated with it—changes much like the numbers on a ruler. It can take on any number of infinite values within a set range.

Ask yourself: all else equal, is 120/79 (category: elevated blood pressure) far more dangerous for a person than 119/79 (category: normal blood pressure)?

It’s a difference of just 1 mm Hg, no more.

If you said no, then you’re on track to unravelling what the ideal blood pressure is and isn’t.

THE LIMITS OF THE HUMAN BODY

We can begin by putting the pieces of this puzzle together with the very basics.

Basic physiology.

Don’t panic, this is an easy lesson and we’ll start, literally, at the bottom.

As with high blood pressure (hypertension), inadequate blood pressure (hypotension) comes with health risks of its own.

So what is our blood pressure’s lower limit; the lowest point at which your brain can continue to make proper sense of this article?

It appears that—measured at the level of the heart—a blood pressure of about 90/60 mm Hg is probably the bare minimum, fully functional, blood pressure in healthy individuals.

This is our baseline. The absolute minimum blood pressure we can risk saying is normal and healthy.

Normal, maybe.

But is this our species’ ideal blood pressure?

Must we aim so precipitously close to the hazards of low blood pressure in order to protect our health from the dangers of elevated blood pressure?

WHEN HIGH BLOOD PRESSURE WAS NORMAL BLOOD PRESSURE

There is some truth in the saying that the greatest danger to a man with high blood pressure lies in its discovery, because ‘then some fool is certain to try and reduce it’.” – Dr. John Hay, writing in the highly respected British Medical Journal (BMJ) in 1931.

In the early 20th century, doctors certainly understood that blood pressures differed between the healthy and the sick.

But they didn’t necessarily think too much of it.

Dr. Paul Dudley White, a graduate of Harvard Medical School, was a leading cardiologist at the time.

He, like many doctors of his period, believed that high blood pressure should not be treated, even if it could be.

In other words, he believed that high blood pressure was an essential way for the body to naturally compensate for some other disease process.

Hence the term “essential hypertension” was born. A term that, to this day, is often used to describe the most common form of high blood pressure.

In hindsight, of course, this type of thinking was a mistake that even altered history.

On April 12th, 1945, the U.S. President, Franklin D. Roosevelt (FDR), died of a stroke.

Surely, his “essential” blood pressure of 300/190 minutes before his death was actually unnecessary, let alone ideal.

Compare that to today, when patients with a blood pressure of “only” 140/90 will be treated—and how.

FDR (bottom center) looking frail just before his death.

IS HIGH BLOOD PRESSURE REALLY THAT BAD?

The last surviving American born in the 19th century was Susannah Mushatt Jones, who lived to be 116.

The secret to old age, according to Jones? Lots of bacon.

Scientists have tried to explain how, other than genetics, lifestyle factors may explain extreme longevity such as this.

A good diet, lots of exercise, strong social connections, and mental stimulation have all been postulated as causes for longevity.

But plenty of people with all of those factors never reach 100.

And, as Jones’ love of bacon illustrates, many centenarians live long and healthy lives without one or many of those factors either.

What’s in little doubt, however, is that high blood pressure is a very serious risk factor for deadly cardiovascular diseases. Cardiovascular (heart and blood vessel) diseases such as stroke.

This is true for mortals and centenarians.

But centenarians start developing hypertension about 30 years after the average person.

And, by extension, they develop cardiovascular diseases only decades after most of us as well.

The implication here is that an ideal blood pressure may be one of the most important keys to a long and healthy life.

NORMAL BLOOD PRESSURE? IT’S YOUR AGE + 100

So what was a normal or ideal blood pressure around FDR’s presidency, when most of today’s centenarians were teenagers?

The formula—a rule of thumb, really—that was used by many physicians in the first half of the 20th century was very simple: no higher than your age + 100.

So if you’re 40, an absolutely normal systolic blood pressure for you would’ve been under 140 mm Hg.

But remember, even if the doctor measured a high systolic blood pressure of 150, he wouldn’t have necessarily treated you.

In fact, he wouldn’t have really been able to—not with any modern medication at least—since the earliest practical blood pressure drugs were first used in the 1940s/50s.

By that time, some doctors started to question the idea of identifying normal blood pressure with a simple formula like that.

As did the guys who love to categorize things more than most of us: actuaries.

DOCTORS & SCIENTISTS? THANK THE ACTUARIES

Actuaries, employed by the insurance industry, measure risk and uncertainty.

While their intentions weren’t entirely noble, you can thank them for some of the earliest, truly substantial, attempts at categorizing normal and abnormal blood pressure.

Their way was paved by Russian physician Nikolai Korotkov, who discovered how to detect a person’s systolic and diastolic blood pressure in 1905.

The next year, the insurance industry started to collect detailed information on blood pressure and its relation to gender, death, and disease in earnest. All, of course, in order to discover the ideal blood pressure; the one with the lowest risk to the insurance industry.

Within a couple of decades, the actuaries started to see a definite trend. People with higher blood pressure were far more likely to die of cardiovascular disease.

Nevertheless, the insurance industry’s methods of measuring and categorizing blood pressure weren’t fail-proof.

And they couldn’t prove that the few available treatments would do anything to lower these risks.

So while the data they gathered provided very important insights, it wasn’t enough to nudge the medical community into changing much, if anything at all, for decades to come.

THE EVER-MOVING TARGET

Even the 1960s was full of experts and medical textbooks that told physicians to ignore, what is now categorized as, high blood pressure.

But in the 1970s, the very first evidence-based medical guidelines on blood pressure finally came to be. Mainly thanks to the cumulative findings painted by research studies published in the 1960s and 70s.

Given those studies, and partly thanks to actuarial data, values of less than 140/90 were categorized as normal blood pressure.

Values of 140/90 to 160/95 were seen as needing monitoring and, on a case by case basis, medication.

Drug therapy was only strongly recommended when the diastolic blood pressure reached at least 105 mm Hg. Moreover, systolic blood pressure—despite evidence of its importance—was basically disregarded in the diagnosis and treatment of hypertension.

With even newer evidence in mind, the medical standards changed substantially by the 1990s. A blood pressure of 140/90 was finally considered truly high and worth treating.

And this remained pretty much standard advice until 2017, when high blood pressure was redefined at a lower level, that of 130/80.

A RISK-FREE BLOOD PRESSURE?

So does that mean that a blood pressure of less than 130/80 is safe, let alone ideal?

All available evidence points to the fact that the risk of cardiovascular disorders grows progressively with increasing blood pressure.

There is no threshold, though. There is no one number where a line is crossed from normal to abnormal. From no risk to some risk.

But the risk of a cardiovascular disorder, like a deadly stroke, is appreciable at least as early as 110/70 – 115/75 mm Hg (depending on how the blood pressure is measured).

Perhaps it’s no surprise, then, that some updated medical texts refer to any systolic blood pressure over 115 mm Hg as high.

Or that lifestyle modifications (like better diet and exercise) should start at 115/75, not 120/80 mm Hg, in some people. Especially those with African ancestry.

Generally speaking then, a blood pressure of less than about 110/70 – 115/75 appears ideal for, at the very least, currently healthy individuals.

Ideal in the sense that this blood pressure helps minimize the risk of many cardiovascular disorders and death.

That being said, much of the evidence for these figures comes from observational studies, which many criticize as being unable to prove a cause and effect relationship. Only an association, even if very strong.

On the other hand, clinical trials are studies that can prove a cause and effect relationship.

Substantial, even if controversial, clinical trials suggest that blood pressure medications should be used to lower a person’s blood pressure as far as reasonably possible in order to reduce the chances of death and disease.

The implication? The lower the better. Again, up to a reasonable point.

Collectively then, these trials seem to bolster the findings of the observational studies.

Moreover, very limited and experimental clinical trial data shows that people with hypertension can lower their blood pressure to, theoretically, (96-99)/67 mm Hg without any medication whatsoever.

These numbers are very close to what some of the “naturally living” tribespeople have throughout their lifetime (95/61 mm Hg).

Perhaps, after all we’ve covered, ~95/60 to 110/70 is a close match to what the ideal blood pressure range is for a healthy member of our species.

Hypothetically, this range may be the level at which the risk of things like stroke from higher blood pressure disappears altogether.

YOUR IDEAL BLOOD PRESSURE MIGHT NOT BE MY IDEAL

Whether lowering a currently hypertensive—or otherwise unhealthy—person’s blood pressure to this “ideal” level is appropriate is a completely different story.

Medicine appears to be moving towards a new paradigm where “normal” or “ideal” blood pressure will be clearly defined in the context of each individual’s unique circumstances. As opposed to broad, arbitrary, population-based categories.

For example, a blood pressure somewhere between 95/60 – 110/70 mm Hg may be the ideal blood pressure of a healthy person.

But is it so for a patient with half a lifetime’s worth of high blood pressure and diabetes? As of now, any answer that you can imagine herein will be met with a degree of controversy.

This illustrates the point that the entire notion of personalized blood pressure control is very complex, nuanced, and highly debated in medicine.

But so was our understanding of the basics of high blood pressure only a few decades ago. When hypertension was defined mainly on the basis of a person’s diastolic blood pressure.

Back then, scientists and physicians threw up their hands and exclaimed that taking a person’s systolic blood pressure into consideration was simply too complex—or worse, irrelevant.

How far we’ve come.

CATEGORIES = HUMAN NATURE

By now, you’re probably wondering why we bother with blood pressure categories. Normal blood pressure, elevated blood pressure, stage 1 hypertension, and stage 2 hypertension.

We know for a fact that nature has no such cutoffs.

Yet we’re human. We love to categorize things, remember?

Like traffic lights at an intersection, blood pressure categories make us and our doctors feel secure. Secure in knowing that there is an easily identifiable “go” signal, rooted in science, at which the benefits of treatment override its risks.

But as with green lights on the road, we need to look both ways for the unexpected consequences of blind obedience to the rules.

*Editorial note: “mm Hg” was purposefully omitted in some places for stylistic reasons.

Author: Artem Cheprasov

Published: September 9th, 2019

See our disclaimer.

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