Hypertension News:

Systolic Reading More Important for Determining Risk

The top number in a blood pressure reading is the more important of the two in determining a person's risk of heart attack and stroke, and doctors should attach more importance to a high reading, according to a new French study.

This is especially true for the elderly, but also applies to middle-aged individuals, the researchers reported in the March 11 Archives of Internal Medicine.

Dr. Athanase Benetos of the Institut de la Sante et de la Recherche Medicale in Paris reported that patients with uncontrolled systolic blood pressure -- measured by the top number -- 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, measured by the bottom number, Benetos said. 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.

In an accompanying editorial that appeared in the journal, Dr. Prakhash Deedwania, of the University of California at San Francisco, said it is appropriate to conclude from the study that strong support exists for considering systolic blood pressure the primary variable for the diagnosis and management of patients with hypertension.

Although it is crucial for health care providers to focus on the systolic reading, Deedwania said such a major shift would require extensive education as well as significant change in physicians' behavior.

He also called for the development of new drugs that can more effectively control systolic blood pressure and a change in the criteria needed for such drugs to be approved by the U.S. Food and Drug Administration.

Deedwania said the lack of aggressive control of systolic blood pressure could be due to a lack of awareness among health care providers, physician attitudes toward aggressive control below recognized high levels, fear that aggressive control will harm the patient and the hesitance to use multiple drugs.

Deedwania said some recent studies suggest that many physicians have higher blood pressure thresholds for diagnosis and treatment than current recommended guidelines. He said it has also been suggested that physicians are particularly less aggressive in treating elderly and ethnically diverse patients with hypertension.

What can patients with high blood pressure do? Deedwania told Medical Week that they should insist on asking their doctors about their systolic pressure and make sure it has been lowered with the hypertensive medication they are receiving.

"It is the level of systolic blood pressure that will determine their subsequent risk of cardiovascular events as well as other target end-organ damage, such as kidneys, brain, vessels, etc.," he added.

Source: Hypertension Week of March 17, 2002