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Item
#5
Top Blood Pressure Number
Key for Gauging Risk
Systolic
blood pressure levels, but not diastolic blood pressure levels,
can predict coronary vascular disease risk.
The top
number in a blood pressure reading is the best way to determine a
man's heart attack and stroke risk, and should be used to guide
treatment, according to a new report. But many doctors continue to
treat patients based on the lower number, and the study authors
believe this practice should change.
The
top number measures systolic blood pressure, the force on blood
vessel walls during a heart beat. The bottom, or diastolic, number
gauges pressure when the heart is at rest between beats. High
blood pressure, or hypertension, is defined as a systolic reading
of 140 millimeters of mercury (mm Hg) or greater or a diastolic
reading of 90 mm Hg or above.
The
diastolic number has conventionally been viewed as a more
sensitive indicator of hypertension, and is the reading that
commonly influences clinical decision-making regarding degree of
disease present and what therapeutic steps should be taken.
In
the current study, lead author Dr. Athanase Benetos of the
Institut de la Sante et de la Recherche Medicale in Paris, France,
and colleagues found that patients with uncontrolled systolic
blood pressure were almost 2.5 times more likely to die of heart
disease than patients with controlled blood pressure.
But
risk of death from cardiovascular disease was not associated with
diastolic blood pressure, the investigators report in the March
11th issue of the Archives of Internal Medicine.
"The
most important result of this study is that cardiovascular
mortality, especially coronary heart disease mortality, is much
higher in uncontrolled hypertensive men than in controlled
hypertensive men, and that systolic blood pressure levels, but not
diastolic blood pressure levels, can predict coronary vascular
disease risk independent of age," the authors write.
The
study also revealed that 85.5% of men being treated for high blood
pressure had uncontrolled systolic or diastolic blood pressure, or
both. These patients had a 66% greater risk of death associated
with heart disease than those men with controlled blood pressure.
"This
clearly confirms that, as measured in a clinical setting, a
controlled blood pressure, especially systolic blood pressure, is
uncommon," Benetos and colleagues write.
Nevertheless, the authors emphasize that treating systolic blood
pressure is of greater value than treating diastolic blood
pressure since it has been shown to be a better predictor of death
from heart disease.
"Our
results show that in clinical practice a well-controlled systolic
blood pressure (less than 140 mm Hg) should be the goal of
antihypertensive treatment," the researchers conclude.
"As
advised in the recent recommendations of the National High Blood
Pressure Education program, it is crucial for healthcare providers
to focus on systolic blood pressure for diagnosis, staging and
therapeutic strategy in hypertension, particularly in the
elderly," Dr. Prakash C. Deedwania of the University of
California, San Francisco, writes in an editorial accompanying the
study.
"It is
also important to emphasize that often more than one, but usually
two or three drugs are needed to achieve optimal control of
systolic blood pressure," he adds.
Archives
of Internal Medicine 2002;162:506-508, 577-581.
By
referring your friends and colleagues to Diabetes in Control you
can win a free scholarship or expense check for the 2002 AADE
conference in Philadelphia.
http://www.diabetesincontrol.com/scholarship.shtml
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