Issue 129 Item 7 Systolic Blood Pressure Key For Gauging Heart Disease Risk

Researchers find 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. 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. 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 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 researchers 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 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.

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.

The results show that in clinical practice a well-controlled systolic blood pressure (less than 140 mm Hg) (130 mm HG if diabetes is present) should be the goal of antihypertensive treatment.

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. Archives of Internal Medicine March 11, 2002;162:506-508, 577-581