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New Advisory On Systolic Blood Pressure

Perhaps, like so many Americans, you've been told that your diastolic blood pressure (the bottom number) counts more in determining your health risk from high blood pressure. This has, in fact, been the prevailing wisdom, up until two years ago when the National Heart, Lung, and Blood Institute (NHLBI) issued an advisory to physicians on the newfound importance of systolic pressure (the top number) in the diagnosis and treatment of hypertension in middle-aged and older adults. According to NHLBI Director, Dr. Claude Lenfant, "it's a better blood pressure indicator than diastolic of your risk of heart disease and stroke."

In an effort to educate health professionals, community organizations, and the general public, NHLBI has launched a new campaign to raise awareness of this important new finding. As most of our readers hopefully know by now, high blood pressure (hypertension) is a very serious condition that affects 50 million Americans, or one in four adults. High Blood pressure is a serious risk factor for heart disease and stroke. Untreated, high blood pressure can also lead to conditions such as kidney damage and blindness. For these reasons, the NHLBI's advisory is especially important.

The new evidence suggesting that systolic blood pressure is the key determinant for assessing the presence and severity of high blood pressure for middle-aged and older adults comes from research such as the long-term Framingham Heart Study. According to the NHLBI, this study "showed that systolic blood pressure alone correctly identified 91 percent of those who may need antihypertensive therapy, while diastolic blood pressure alone correctly identified only 22 percent of them. Among those over age 60, systolic blood pressure alone was even better able that diastolic pressure alone to correctly classify blood pressure. The study involved nearly 5,000 persons."

Blood pressure is the measure of the force of blood flowing against artery walls. Systolic pressure occurs when the heart is actively pumping. Diastolic is the pressure on the arteries when the heart is at rest. Research suggests that diastolic blood pressure rises until around age 55 and then declines. Systolic pressure, on the other hand, increases steadily with age. According to the HBLBI, "for many older Americans, only the systolic blood pressure is high, a condition known as 'isolated systolic hypertension,' or ISH (systolic at or above 140 mm Hg and diastolic under 90 mm Hg). In fact, for older Americans, ISH is the most common form of high blood pressure. Sixty-five percent of all hypertensives over age 60 have ISH." Unfortunately, older Americans have the poorest rate of hypertension control. It is estimated that only 18% of white American hypertensives over the age of 70, and 25% of African Americans have blood pressure under control to less than the140/90 mm Hg standard.

Research has shown that controlling ISH significantly reduces heart attack, heart failure, and stroke. Do you know if you are among the millions of at-risk Americans with high blood pressure? Do you know if your systolic pressure is above 140 mm Hg? Regardless of your age, it's important to know your blood pressure and to seek treatment early to prevent organ damage, heart disease, and stroke. Have your blood pressure taken often, or take it yourself with a home monitor. Keep a record of your blood pressure readings and share it with your doctor. Talk to him or her about your blood pressure readings. Importantly, if you are currently taking medication for high blood pressure, don't stop taking it without consulting with your physician. If the medication you are taking is causing undesirable side effects, ask your doctor to prescribe another medication that might be more agreeable. For your health's sake, please don't ignore this important advisory!


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