Tracking Top Number in Blood Pressure May Be Enough

By Steven Reinberg
HealthDay Reporter
Wednesday, June 18, 2008; 3:00 AM

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TUESDAY, June 17 (HealthDay News) -- For patients over 50, doctors tracking hypertension may only need to monitor systolic blood pressure, ignoring diastolic blood pressure, British experts suggest.

Systolic blood pressure -- the top number in a reading -- is the pressure exerted at the beginning of the heart's pumping cycle, while diastolic pressure records the lowest pressure during the heart's resting cycle. Both pressures are routinely measured when taking blood pressure.

"We felt that trying to communicate two pressures to patients is a very confusing message," said Dr. Bryan Williams, a professor of medicine at the University of Leicester and Leicester Royal Infirmary, U.K., and co-author of a Viewpoint article in the June 17 online issue of The Lancet.

"If we could just get patients to focus on a single number, and recognize that that number needed to be lowered, it might help in both communicating the message and also improving treatment," Williams said.

Because there is such an emphasis on diastolic pressure, patients are not getting their systolic blood pressure adequately controlled, Williams contends. "We felt the best way of dealing with this was to say that people over the age of 50 probably didn't even need to measure diastolic -- it's only the systolic we should be focusing on," he said.

Some experts in the United States have long pushed for the change. In 2000, a National Institutes of Health-sponsored group published an advisory in the journal Hypertension that supported a clinical focus on systolic pressure.

As the population ages, a rise in systolic pressure resulting in what is called systolic hypertension is becoming more common, especially in people over 50, compared with diastolic hypertension, Williams noted.

Generally, systolic blood pressure continues 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.