What Should My Blood Pressure Be?

Updated July 2026

Blood pressure is one of the most important numbers for your heart — and one of the most misunderstood. Nearly half of American adults have high blood pressure, and only about one in four have it under control. If yours came back high, that's worth taking seriously. But here's the encouraging part: more of your blood pressure is within your control than almost any other cardiovascular risk factor.

What is blood pressure, and what do the two numbers mean?

Blood pressure is the force of your blood pushing against your artery walls, written as two numbers. The top number, “systolic”, is the pressure when your heart beats. The bottom number, “diastolic”, is the pressure when it rests between beats. Both are measured in millimeters of mercury (mmHg). A reading of 118/78 mmHg means a systolic of 118 mmHg over a diastolic of 78 mmHg.

What should my blood pressure be?

For most adults, a normal blood pressure falls below 120 for the systolic number and below 80 for the diastolic reading, which means everything above that (for either top or bottom number) is considered elevated.

The current categories set by the American Heart Association and American College of Cardiology run like this: normal is below 120/80; elevated is 120–129 on top and below 80 on the bottom; stage 1 hypertension is 130–139 or 80–89; and stage 2 hypertension is 140/90 or higher. The 2025 AHA/ACC guideline kept the 130/80 definition and set a treatment goal of below 130/80 for most people.

Two things I always add for patients: there's no such thing as a blood pressure that's too low as long as you feel well with it — mine runs around 96/60 and I feel fine — and in some older adults, pushing the top number much below 140 can cause lightheadedness, so the right target is individualized. That's a conversation to have with your own doctor. After all, guidelines are based on averages, and no one is average.

Why does high blood pressure matter?

Because it quietly wears down your arteries and heart for years before you feel a thing. Think of elevated pressure as a hammer striking your artery walls: the higher the pressure, the more forceful the blow, and the more damage those walls take over time. High blood pressure speeds up the buildup of plaque, raises the risk of aneurysms and stroke, damages your kidneys, and is the leading cause of heart failure in this country. It also takes a toll on the brain, which is why keeping it controlled helps protect memory and thinking as you age. Blood pressure is not something you can feel — which is exactly why knowing your BP number matters.

What causes high blood pressure?

In the vast majority of cases it isn't one thing, it's many small things adding up. Doctors refer to this as "essential" hypertension, but that makes it seem like it just happens. And that's not true. I look at it as straws on a camel's back. Pile on enough straws and the camel falls over (you have high blood pressure); take a few away and it stands right back up (you might not need those medications after all).

A couple of straws you can't remove — age and family history — but most you can: excess weight, inactivity, a diet low in fruits and vegetables, too much sodium, too much alcohol or caffeine, smoking, poor or non-restorative sleep including sleep apnea, and chronic stress. A few medical contributors like thyroid disease, kidney disease, and unmanaged pain are ones your doctor can help address. But most of the straws are in your hands, and that's the good news. One note specifically for women – if you experienced eclampsia, pre-eclampsia, or high blood pressure during or after pregnancy, you have a higher likelihood of developing hypertension down the road. Use that knowledge to track your blood pressure more closely – and certainly don't skip routine medical visits.

Why isn't one reading enough to diagnose it?

Because blood pressure is always changing. It oscillates minute to minute around an average, and a single office reading captures just one moment — often a stressful one. A real diagnosis relies on multiple readings over time, ideally taken at home where you actually live. The current guidelines now treat home monitoring as the gold standard for confirming high blood pressure and guiding treatment.

Home BP monitoring also catches two common traps: "white coat" hypertension, where readings spike only at the doctor's office, and "masked" hypertension, where they look fine in the office but run high the rest of the day. How to measure your blood pressure at home walks through doing it right.

How can I lower my blood pressure?

Lifestyle first — and it works, often as well as a medication. People respond differently, but the approximate drops in the top number add up fast: losing weight can cut 5–20 mmHg per 20 pounds lost; a healthful diet, 8–14; cutting sodium, 2–8; regular activity, 4–9; and reducing alcohol, 2–4. Put those together and a 20-to-55 mmHg drop in systolic pressure is realistic — the same result you'd expect from a handful of drugs. Even partial progress helps, and it makes any medication you do take work better at lower doses. For the how-to, see how to lower blood pressure naturally, what to eat and what to avoid, why sodium matters so much, and the 15-minute exercise that lowers it.

What about medication?

Sometimes it's necessary, and there's no shame in that. Under the current guidelines, medication is generally started at 140/90 or higher, or at 130/80 and above for people at higher cardiovascular risk — those with existing heart disease, diabetes, kidney disease, or an elevated estimated risk. There are many effective drugs, and finding the right one or combination can take some adjustment. But the more you do on the lifestyle side, the fewer medications you will likely need — and every drug carries potential side effects that lifestyle changes simply don't. Can you lower blood pressure without medication? covers that trade-off honestly.

Where does food fit in?

Food may be the most powerful lever of all, because it works on multiple blood pressure relevant pathways at the same time. Whole-food fiber, potassium-rich fruits and vegetables, and healthy fats push readings down, while excess sodium pushes them up. There's also a real, two-way link between blood pressure and mental health — low mood can drive pressure up, and the low-grade inflammation of untreated hypertension can worsen mood.

I once had a customer march into our office convinced we'd slipped antidepressants into our foods, because he'd never felt better. We hadn't. He was simply feeding his body in a way that supports health on every level. That's the whole idea behind Step One Foods: whole-food nutrients, as low in sodium as possible (our pancake mix contains baking powder which is the sodium source), high in fiber, potassium and antioxidants - built to help your heart the way food is meant to. It won't replace every lifestyle change, but it's a genuinely good place to start.

If you're new to this site and found this useful, I write one of these evidence-based articles every week. You can get them in your inbox by joining my email list at the bottom of this page. No spam, no requirement to buy anything, just practical knowledge.