Systolic: New Blood Pressure Advice
I told my patients to pay close attention to the diastolic,
or lower, blood pressure. And I asked them not to be overly
concerned if their systolic, or upper, blood pressure went astray.
The latter normally rises with age, I would instruct my patients
-- passing on to them information instilled into me during my
Ounce of Prevention
Elizabeth Smoots, M.D.
But times change in medicine. Today the bulk of evidence points
to systolic, not diastolic, pressure as the key to high blood
pressure detection and treatment success. In a dramatic reversal
in policy, on May 4, 2000, an expert committee of the National
Heart, Lung, and Blood Institute (NHLBI) announced that systolic
pressure is the most accurate blood pressure measurement for
older adults. The new guidelines hold true for all those with
hypertension who are over age 40 -- a group that makes up the
majority of 50 million Americans with the disease.
Shifting focus to systolic
"Don't ignore your systolic," urges Claude Lenfant, M.D., director
of the NHLBI in an advisory. "If you're middle-aged or older,
it's a better blood pressure indicator than diastolic of your
risk of heart disease and stroke." For example, long-term findings
from the Framingham Heart Study show that systolic blood pressure,
which measures the force inside your arteries when your heart
contracts, correctly identifies 92 percent of those at risk
for cardiovascular. In contrast, diastolic pressure, which measures
the force while your heart relaxes, identifies only 22 percent
of those at risk.
The evidence also shines when it comes to preventing the problems
that frequently accompany surging blood pressures. A study published
in Archives of Internal Medicine, in which researchers
followed 5,000 older Americans for five years, found those who
received treatment for elevated systolic blood pressures --
which was formerly ignored -- had average rate reductions of
27 percent for heart attack, 55 percent for heart failure, and
37 percent for stroke.
Recently, several other studies have shown similar results.
The findings indicate that, much like treatment of high diastolic
pressure, lowering systolic pressure helps protect against heart
disease and stroke -- the nation's first- and third-leading
causes of death -- as well as kidney damage, dementia, and blindness.
Better pressures on my mind
Despite the new consensus, I still see far too much hypertension
going unchecked. The National Institutes of Health reports that
only 68 percent of people with high blood pressure are aware
they have the condition, about 54 percent get treatment, and
a mere 27 percent successfully lower their pressures to the
desired range. Realistically, these figures are probably even
worse, since they were collected before systolic pressures became
recognized as the key indicator in older adults.
Now we know that a high systolic pressure is not just
a part of the normal aging process. According to the
current view, it's a sign of stiffening of the arteries
due to widespread arteriosclerosis that may result
in heart disease, stroke, and other forms of cardiovascular
Many doctors have long held the belief that an acceptable systolic
reading is "100 plus your age." Now we know, however, that a
high systolic pressure is not just a part of the normal aging
process. According to the current view, it's a sign of stiffening
of the arteries due to widespread arteriosclerosis that may
go on to heart disease, stroke, and other forms of cardiovascular
"Systolic hypertension is a major health threat, especially
for older Americans," concludes Dr. Lenfant. "While it cannot
be cured, systolic hypertension can be treated and its complications
[can be] prevented."
Here's where to begin: No matter what your age, work with your
provider toward a blood pressure goal below 140/90 for both
numbers. For those with diabetes or other chronic ailments,
the NHLBI recommends aiming for an even lower target of 130/85.
And start treatment early -- using diet, exercise and medication
-- to maximize prevention of heart disease and stroke. For your
long-term health, I cannot emphasize enough the importance of
assuaging your systolic blood pressure.
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Elizabeth Smoots, M.D., F.A.A.F.P., is a board-certified family
physician in Seattle, Washington. A fellow of the American Academy
of Family Physicians, Dr. Smoots specializes in prevention and
primary care medicine.