What does a blood pressure of 120/45 indicate?

From the Guidelines

A blood pressure of 120/45 indicates a wide pulse pressure with a normal systolic pressure but an abnormally low diastolic pressure, suggesting isolated diastolic hypotension, which requires medical evaluation. This reading is concerning because the diastolic pressure of 45 mmHg is significantly below the normal threshold of 60-80 mmHg, as indicated in the 2007 guidelines for the management of arterial hypertension by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) 1. The wide pulse pressure (the difference between systolic and diastolic) of 75 mmHg may cause symptoms like dizziness, lightheadedness, or fatigue, especially when standing.

Some key points to consider:

• The systolic pressure of 120 mmHg falls within the normal range, according to the guidelines 1.
• The diastolic pressure of 45 mmHg is significantly below the normal threshold, which may indicate conditions such as aortic regurgitation, arteriovenous fistula, severe anemia, or medication side effects.
• The low diastolic pressure is concerning because it may reduce coronary artery perfusion, potentially affecting heart muscle blood supply.
• It is essential to contact a healthcare provider promptly for assessment and guidance, as this condition may require medical attention.

Until a doctor can be seen, it is recommended to:

• Monitor blood pressure regularly
• Stay hydrated
• Be cautious when changing positions to avoid falls
• Not adjust any current medications without medical guidance, as stated in the guidelines for managing arterial hypertension 1.

From the Research

Blood Pressure Reading 120/45

• A blood pressure reading of 120/45 indicates a systolic blood pressure of 120 mmHg and a diastolic blood pressure of 45 mmHg.
• According to the study 2, a diastolic blood pressure below 70 mmHg may be a concern, as it can lead to tissue hypoperfusion.
• The European Society of Cardiology and European Society of Hypertension (ESC/ESH) 2018 guidelines recommend a lower safety cut-off for in-treatment diastolic blood pressure of ≥70 mmHg 2.
• A diastolic blood pressure of 45 mmHg is significantly lower than the recommended safety cut-off, which may increase the risk of cardiovascular events.

Risks Associated with Low Diastolic Blood Pressure

• Studies have shown that extremely low diastolic blood pressure can be associated with increased adverse cardiovascular events, such as myocardial infarction and stroke 3.
• A diastolic blood pressure of less than 60 mmHg has been linked to a higher risk of cardiovascular events, including nonfatal myocardial infarction and nonfatal stroke 3.
• Additionally, low diastolic blood pressure has been associated with atherosclerosis, particularly in elderly subjects 4.

Clinical Implications

• The study 5 suggests that hypotensive events, particularly those induced by diastolic blood pressure, can cause myocardial ischemic events in patients with coronary disease.
• The findings of the study 6 emphasize the importance of considering both systolic and diastolic blood pressure in the management of hypertension, as well as the potential risks associated with low diastolic blood pressure.
• Overall, a blood pressure reading of 120/45 may indicate an increased risk of cardiovascular events, and further evaluation and management may be necessary to mitigate this risk 2, 3, 5, 4, 6.