Older Patients May Only Need Systolic Pressure Measured

For people aged 50 years or older, diastolic blood pressure may not be as relevant

WEDNESDAY, June 18 (HealthDay News) -- Patients 50 years of age or older are best tested for high blood pressure using systolic blood pressure only, because the burden of cardiovascular disease is due largely to systolic pressure, according to an editorial published online June 17 in The Lancet.

Bryan Williams, M.D., of the University of Leicester in the United Kingdom, and colleagues write that current practice is to use systolic and diastolic pressure to measure high blood pressure, but diastolic pressure is less relevant to older people because it stops rising after about age 50. At that time, peripheral vascular resistance becomes a less important factor in determining blood pressure than arterial structural damage and disease. People younger than 50 should continue to get two measurements -- systolic and diastolic -- because for them, diastolic pressure remains a concern, the authors note.

Risk of cardiovascular disease rises as systolic pressure builds from 115 mm Hg, with most medical guidelines advocating a goal of below 140 mm Hg, the editorialists write. Prospective, randomized clinical trials are needed, however, to determine the optimal goal for systolic blood pressure treatment.

"We believe that systolic blood pressure should become the sole defining feature of hypertension and key treatment target for people over age 50 years," the authors conclude. "[This] will simplify the message for practitioners and for patients, will improve awareness and understanding of treatment objectives, and will ultimately lead to more effective treatment of high blood pressure."

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