How Does Blood Pressure Work?

Your heart is the master pump for all the blood in your body. With every heartbeat, your heart pushes your blood to all the vital parts of your body, such as muscles and bones, through a network of arteries, capillaries, and veins. As blood flows through the tube-like arteries, it presses up against the walls of the blood vessels with varying degrees of strength. The strength or weakness of this pressure is called your blood pressure (BP).

Each time your heart squeezes, moving your blood to its various destinations, your blood pressure goes up—this number is referred to by a blood pressure reading as systolic. Then, as the heart relaxes after each contraction, your blood pressure goes down; that is called the diastolic reading. Together, these two numbers are presented as a score, systolic over diastolic: Your doctor might tell you that your BP is “120 over 80.”

According to the American Heart Association (AHA), normal blood pressure should reflect systolic pressure between 90 and 120, over a diastolic pressure between 60 and 80. Your doctor may take this measurement with a fancy-named instrument called a sphygmomanometer—an inflatable rubber cuff attached to a manual air pump. When the doctor inflates the cuff at your arm with air, it temporarily cuts off blood flow, and when it releases, the blood starts flowing again, revealing those two key numbers.

Nowadays, though, doctors are recommended to use an automatic blood pressure cuff, which relies on a different method and seems to be more accurate. While the manual cuff relies on auscultation, in which the doctor listens for the correct pressures using a stethoscope/microphone, automatic blood pressure cuffs are usually oscillometric. When blood passes under the cuff, the arm increases in circumference ever so slightly. And by measuring the amplitude of the oscillations (hence oscillometric) at a continuous interval of pressures, blood pressure can be calculated in much the same way.

If you have high blood pressure, a.k.a. hypertension—approximately 130/80 or higher in a person of average health—your heart is working too hard to pump the blood through your body, which becomes dangerous. According to the AHA [PDF], elevated blood pressure is 120–129/less than 80; hypertension stage 1 is 130–139 (systolic) or 80–89 (diastolic); and hypertension stage 2 is 140 or higher (systolic) or 90 or higher (diastolic). If your blood pressure hits 180/120, you're in hypertensive crisis, and you should get help.

If you fall into the above categories, your doctor will recommend changes to diet and exercise and probably medication. High blood pressure is often a precursor to heart disease or a heart attack and can be a side effect of other diseases, such as diabetes. However, your blood pressure can temporarily rise due to stress, pregnancy, and even some common medications, including over-the-counter pain relievers and antidepressants. One high reading will not necessarily mean you have hypertension—but it’s good to keep vigilant.

Editor's note: This story was updated in July 2018 to reflect new blood pressure guidelines from the AHA.