A blood pressure of 118/60 is technically within the normal range, but the bottom number sits right at a borderline that deserves attention. The American Heart Association’s 2025 guidelines define normal blood pressure as below 120/80, and your systolic (top) number of 118 fits comfortably there. The diastolic (bottom) number of 60, however, lands at the very edge of what some researchers consider too low.
What the Numbers Mean
Blood pressure readings have two parts. The top number (systolic) measures the force when your heart beats. The bottom number (diastolic) measures the pressure between beats, when your heart is resting and refilling with blood. At 118, your systolic pressure is nearly ideal. At 60, your diastolic pressure is at the low end of what’s considered acceptable.
The current AHA/ACC guidelines break blood pressure into clear categories:
- Normal: below 120/80
- Elevated: 120 to 129 systolic with diastolic below 80
- Hypertension Stage 1: 130 to 139 systolic or 80 to 89 diastolic
By these standards, 118/60 falls into the normal category. But these guidelines were designed primarily to flag high blood pressure. They don’t say much about when the bottom number is too low.
Why a Diastolic of 60 Is Worth Watching
Researchers at the University of Alabama at Birmingham coined the term “isolated diastolic hypotension” to describe exactly this pattern: a normal systolic reading (above 100) paired with a diastolic reading below 60. Their research found that older adults with this pattern face an increased risk of developing heart failure over time.
The reason comes down to how your heart feeds itself. Your coronary arteries, the blood vessels that supply your heart muscle with oxygen, fill primarily during the resting phase between beats. That’s the phase your diastolic number reflects. A low diastolic pressure means less blood and oxygen reaching the heart during each rest period. Over months and years, this low-level oxygen shortage can gradually weaken the heart muscle.
At exactly 60, you’re sitting right on the threshold. A reading of 62 or 63 wouldn’t raise the same concern. But if your diastolic regularly dips into the mid-to-low 50s, the risk profile changes.
Your Age and Fitness Level Matter
For a young, physically active person, 118/60 is often completely normal and even expected. Regular exercise strengthens blood vessels and improves blood flow, which naturally lowers resting blood pressure. Athletes commonly have diastolic readings in the low 60s or even high 50s without any negative effects.
For older adults, the picture is different. Aging arteries become stiffer, and a low diastolic reading in someone over 65 can signal that the heart isn’t generating enough pressure to keep blood flowing well between beats. Older adults with low diastolic pressures are more likely to experience fatigue, dizziness, and falls. If you’re an older adult and your diastolic is consistently at or below 60, that’s a conversation worth having with your care team, especially if you’re taking blood pressure medication that could be driving it lower.
The Pulse Pressure Factor
There’s another number hidden in your reading: pulse pressure. This is simply the top number minus the bottom number. For 118/60, that’s 58. A healthy pulse pressure generally falls around 40. Values above 60 are considered a risk factor for heart disease, particularly in older adults, because they suggest the large arteries are becoming stiff.
At 58, your pulse pressure is elevated but not yet in the high-risk zone. In a younger person, this gap is less concerning. In someone over 60, it could reflect early arterial stiffness, a condition where cholesterol buildup and age-related changes make artery walls less flexible. Stiff arteries push systolic pressure up and let diastolic pressure drop, widening the gap between the two numbers.
Symptoms That Signal a Problem
Most healthcare professionals consider blood pressure too low only when it causes symptoms. If you feel perfectly fine at 118/60, the reading alone isn’t cause for alarm. But pay attention to these signs:
- Dizziness or lightheadedness, especially when standing up quickly
- Fatigue that doesn’t improve with rest
- Blurred or fading vision
- Trouble concentrating
- Fainting or near-fainting episodes
A sudden drop of just 20 points in either number can trigger dizziness or fainting. If you notice these symptoms after standing up from a seated or lying position, you may be experiencing orthostatic hypotension, a temporary but potentially dangerous drop in blood pressure related to position changes.
Getting an Accurate Reading
Before worrying about a single reading, make sure you’re measuring correctly. A poorly taken reading can be off by 10 points or more in either direction, which would completely change the interpretation.
The American Heart Association recommends using an automatic, cuff-style monitor that wraps around your upper arm. Wrist and finger monitors give less reliable results. The cuff size matters too: a cuff that’s too small or too large will skew the reading. Before measuring, avoid caffeine, exercise, and smoking for at least 30 minutes. Empty your bladder, then sit quietly for five minutes with your arm resting on a flat surface at heart level. Don’t talk during the measurement.
Take your home monitor to a medical appointment once a year to compare its readings against clinical equipment. If your 118/60 reading was a one-time measurement, take it again over several days at the same time to see if the pattern holds. A single reading is a snapshot. A trend across multiple readings tells the real story.
The Bottom Line on 118/60
If you’re young and active with no symptoms, 118/60 is a healthy reading. If you’re older, on blood pressure medication, or experiencing dizziness and fatigue, the diastolic number of 60 and the pulse pressure of 58 both warrant a closer look. Track your readings over time and note whether the diastolic trends downward, as that’s more informative than any single number on its own.