All That Matters Is Systolic Blood Pressure (At least for those over 50 years of age)
By R.C. Goode
High blood pressure (hypertension) in younger adults is caused by narrowing of the arteries and smaller arteries. In older adults the larger arteries play a more significant role in one’s blood pressure. These large arteries become stiffer, lose some of their elasticity and do not “give” when the heart contracts which results in a higher blood pressure followed by a lower diastolic blood pressure. Usually the diastolic pressure has been used to determine if treatment is necessary and systolic pressure ignored.
A problem is that diastolic pressure declines in those 50 years and on. Thus the increase in cardiovascular disease with age attributed to blood pressure will be mostly related to systolic pressure. The risk of cardiovascular disease rises as systolic blood pressure increases from 115mmHg. It has been shown that in patients with high systolic blood pressure, treatment to lower this value has resulted in cardiovascular benefit.
The authors believe the systolic blood pressure in adults over 50 years of age should be the focus as it is more easily measured than diastolic blood pressure and a better predictor of risk for heart disease. By focusing on a single measurement for those over 50 years health professionals have the potential to improve the treatment for high systolic pressure and reduce the incidence of death due to heart disease.
In patients under 50 years of age, diastolic and systolic blood pressure should be monitored as they are more at risk for a rising diastolic value than those over 50 years of age.
The authors of this position paper conclude “we believe that systolic blood pressure should become the sole defining feature of hypertension and key treatment target for people over the age of 50 years.”
Williams B, Lindholm L, Sever P. Systolic pressure is all that matters, Lancet 2008; 371: 2219-2221.
Written by R.C. Goode
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