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

(Click to read “Talk Test and Breath Sound Check”)

Disability & Death Rate

Life expectancy has increased considerably in the last decade. Information from research studies such as the Harvard Longitudinal Study, indicate that we can expect to live to 85 years when one is congruent with the "predictors."

Learn More

Tim Russert: A Tragedy - Sudden Death But Was It Unannounced?

It is difficult to understand the loss of an adult in the most productive phase of life. In general, it is believed that living to 85 years of age is an expectation, especially if following the predictors set forth by George Valliant, Director of the Harvard Longitudinal Study, and author of AGING WELL.

Learn More

Can't Quit Even If I Wanted To

Joseph Difranza has reported a possible explanation as to why it is so difficult to quit smoking, even when a smoker no longer gets pleasure from smoking. Biological evidence shows that when an individual smokes a cigarette, the nicotine level rises in the blood.

Learn More

Friends, Family, the Framingham Heart Study and Obesity 2007

The "person-to-person" spread of obesity is a recent observation of Nicholas Christakis and James Fowler (2007). These investigators examined the data from the Framingham Heart Study which included ~ 12,000 subjects.

Learn More

Risk Factors

There are circumstances and lifestyles than can increase the "risk" or probability of developing coronary artery disease. These are called "risk factors"

Learn More