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Tracking Top Number in Blood Pressure May Be Enough
Date:6/17/2008

ues to increase with age, while diastolic pressure starts to drop after age 50, which is the same time cardiovascular risk begins to rise. Therefore, there is an increased prevalence of systolic hypertension past age 50, whereas diastolic hypertension is practically nonexistent.

"It's pretty pointless to measure diastolic pressure, since it's falling anyway," Williams said. "Rising systolic pressure is the most significant factor in causing strokes and heart disease," he said. "That's what we need to be focusing on."

Using systolic blood pressure alone after age 50 should simplify treatment for doctors, policymakers and even drug companies by getting them to focus on ways to lower systolic pressure, Williams said.

Using systolic pressure alone focuses physicians' attention on what needs to be treated, since many may still be using diastolic pressure to guide treatment decisions, Williams said.

For people under 50, the scenario may be different. About 40 percent of adults under 40 years of age have diastolic hypertension, and about a third of those between 40 and 50 have the problem. For these patients, there needs to be a continued emphasis on both systolic and diastolic blood pressures, Williams's group said. However, controlling systolic blood pressure, even among these younger patients, almost always results in adequate control of diastolic blood pressure, too, they noted.

But one expert believes that there are still important reasons to concentrate on systolic and diastolic blood pressure for patients of any age.

"Inadequate control of hypertension contributes to a substantial proportion of preventable cardiovascular events worldwide," said Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles. "Elevations in systolic as well as diastolic blood pressure contribute to this cardiovascular risk, although in patients over age 50,
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