According to recent estimates, approximately one in three American adults suffers from hypertension, but because there are no symptoms, nearly one third of these people are unaware they have it. In fact, many people have high blood pressure for years without knowing it. Uncontrolled hypertension can lead to high stroke, heart attack, heart failure or kidney failure. This is why it is often called the “silent murderer.” The only way to know if you have hypertension is blood pressure.
For patients over 50, doctors tracking hypertension may be necessary to control systolic blood pressure, ignoring diastolic blood pressure, British experts suggest.
Systolic blood pressure – the top number in a reading – is the pressure at the beginning of the heart’s pumping cycle, while diastolic pressure records the lowest pressure during the rest of the heart cycle. The pressures are measured when taking blood pressure.
“We think of trying to communicate two pressures to patients is a very confusing message,” said Dr. Bryan Williams, professor of medicine at the University of Leicester and Leicester Royal Infirmary, UK, and co-author of an article opinion on June 17 at the line number of the Lancet.
“If only we could get patients to focus on one issue, and recognize that this number should be reduced, could help in both communicating the message and also improve treatment,” said Williams.
Because there is so much emphasis on diastolic pressure, patients are not receiving the systolic blood pressure adequately controlled, Williams contends. “We feel that the best way to deal with this was to say that people over 50 years, probably not even need to measure diastolic – it’s just the systolic pressure should focus on” what he said.
Some U.S. experts have long pressed for change. In 2000, the National Institutes of Health-sponsored by the Consultative Group has published in a journal Hypertension that supported a clinical focus on systolic pressure.
As the population ages, an increase in systolic blood pressure that occurs in what is known as systolic hypertension is increasingly common, especially in people over 50 years, compared with diastolic hypertension, Williams said.
In general, systolic blood pressure continues to increase with age, while diastolic pressure starts to decrease after 50 years of age, cardiovascular risk is at the same time, begins to rise. Therefore, there is a greater prevalence of systolic hypertension past age 50, while diastolic hypertension is practically nonexistent.
“It’s pretty pointless to measure diastolic pressure, as it is falling anyway,” said Williams. “The increase in systolic pressure is the most important factor in triggering heart disease,” he said. “This is what we should focus on.”
Using systolic pressure alone after age 50 should simplify treatment for doctors, politicians and pharmaceutical companies, including getting them to focus on ways to reduce the systolic pressure, Williams said.
Using systolic pressure alone focuses physicians’ attention on what needs to be treated, as many may still be using diastolic pressure to guide treatment decisions, Williams said.
For people under 50, the stage may be different. About 40 percent of adults under age 40 have diastolic hypertension and about a third of people between 40 and 50 have the problem. For these patients, there should be a continued focus on systolic and diastolic, Williams told the group. However, control of systolic blood pressure, even among younger patients, almost always results in adequate control of diastolic blood pressure, also scored.
For people 50 and older, systolic pressure is high if it is 140 mmHg or more, according to the Heart of the U.S. National, Lung and Blood Institute.
However, one expert believes that there are still important reasons to focus on systolic and diastolic blood pressure in patients of all ages.
“Inadequate control of hypertension contributes to a significant proportion of preventable events worldwide cardiovascular,” said Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy University of California at Los Angeles. “Elevations in systolic and diastolic blood pressure contribute to cardiovascular risk, even in patients over 50 years, elevated systolic blood pressure impart greater relative risk,” which, he said. There are many natural remedies to help hyper tension. Some aid supplement to inflammation seems to emphasize that the suffering of many blood pressure, and other support vessel constriction, stress and other factors associated with hypertension.
The purpose of this point of view to only use systolic hypertension for the diagnosis and treatment of hypertension in patients over 50 years, while thought-provoking and with the laudable aim of improving the treatment and control of systolic blood pressure can have unintended consequences that require further consideration, Fonarow said.
“The achievements in achieving better control of diastolic blood pressure in recent decades may be lost if the sole purpose of hypertension guidelines becomes systolic blood pressure,” Fonarow said. “Studies have suggested that the reduction in diastolic blood pressure to very low levels may increase cardiovascular risk in patients with coronary artery disease, under this single dimension proposal, this risk could be hidden,” he said.
“In addition, measurement of systolic and diastolic blood pressure are essential components of global cardiovascular risk assessment using the Framingham study and other results of risk assessment, hence the need to maintain the routine measurement of diastolic blood pressure “Fonarow said.
After all this debate that remains is the fact that hypertension is a silent murderer in the United States and if nothing changes, it is likely that the incidence of hypertension will increase.