Is Diastolic Hypertension Irrelevant In The New Millennium
In accordance with current guidelines, as well as in clinical practice, we measure and treat both systolic and diastolic blood pressure and aim for the recommended ideal of < 140/85 mmHg. However, due to the overwhelming evidence of the importance of systolic hypertension, it has even been suggested that one should not even bother measuring DBP., The personal view in the BMJ by Peter Sever even recommends that we abandon measuring DBP, except in cases where diastolic hypertension was suspected. Perhaps a society for the abolishment of measurement of DBP should be established!
Indeed, there is little published evidence of significant risk posed by isolated diastolic hypertension . The Copenhagen Heart Study did not find an association between IDH and risk of stroke after a 12 year follow-up of 6545 patients. The Multiple Risk Factor Intervention Trial found that for any level of DBP, SBP was the major determinant of cardiovascular risk. It has to be noted that in both these studies most of the study subjects were white Caucasians and in the Copenhagen Heart Study, aged over 50 years of age.
Preventing Low Blood Pressure
To help prevent low blood pressure, drink plenty of fluids, preferably water, to prevent dehydration. Stand up slowly from a sitting position to help prevent orthostatic hypotension.
Also, notify your doctor right away if you feel a medication is causing your blood pressure to drop. There may be another medication option that will have less impact on your blood pressure numbers.
In addition, if youve been diagnosed with any medical conditions known to be linked with low blood pressure, talk to your doctor. Discuss which symptoms you should look out for and how to best monitor your condition.
Evolution Of Importance Of Sbp
For a long time, guidelines, clinical trials and clinical practice have based greater importance on DBP levels. The first JNC report in 1977 defined DBP as the basis for detection and treatment. For example, an individual with blood pressure of 180/85 mmHg was not eligible for treatment under the old guidelines. In fact, it was felt that systolic hypertension, due to hardening and loss of elasticity of the major arteries was an unavoidable consequence of aging and augmented by hypertension, in contrast to DBP which was thought to be a function of peripheral resistance. Therefore SBP continues to rise with advancing age while DBP stabilizes or declines, giving rise to isolated systolic hypertension . For example, Silagy et al found that the prevalence of ISH increased from 0.8% in 50-year-old subjects, 5% in 60 year olds, 12.6% in 70 year olds, and up to 23.6% in 80 year olds. Certainly one of us remembers a story of an eminent geriatrician lecturing that SBP should not be reduced in the elderly, as these patients would fall over from reduced cerebral perfusion and sustain strokes!
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Which Is More Important: Systolic Or Diastolic Blood Pressure
When it comes to measuring high blood pressure , many wonder whether the number on top is more important than the number on the bottom .
Typically, systolic blood pressure is given more attention as a risk factor for heart disease. However, both systolic and diastolic blood pressure are equally important in monitoring the health of your heart.
What the numbers measure
- Systolic blood pressure indicates the amount of pressure being exerted on the walls of your arteries when your heart beats.
- Diastolic blood pressure indicates the amount of pressure being exerted on the walls of your arteries in between heartbeats.
Blood pressure ranges
- Normal: Under 120/80 mm Hg
- Elevated: 120-129 systolic, under 80 mm Hg diastolic
- Hypertension Stage I: 130-139 systolic, 80-89 mm Hg diastolic
- Hypertension Stage II: Over 140/90 mm Hg
- Hypertensive crisis: Over 180/120 mmHg. This is a dangerously high reading and requires immediate medical attention.
How Do Doctors Diagnose High Blood Pressure
Because symptoms are so uncommon, the only way to know you have HBP is to have your blood pressure tested at your doctors office. Your doctor will use a device called a sphygmomanometer, which features an inflatable cuff that wraps around your upper arm. The cuff is attached to a scale, and when it inflates, it measures your systolic BP. It measures your diastolic BP as the cuff slowly deflates. Your doctor will also likely press a stethoscope to listen for any abnormal sounds as your blood flows.
You officially have HBPyour doctor may call it hypertensionwhen your readings are above normal during at least two visits to the doctor. However, many doctors will ask you to measure your own blood pressure using either a home monitor or with a 24-hour monitoring device your doctor lends you. Doing this will help confirm that your blood pressure remains high during the normal course of your day.
Why is this important? Many people have whats called white-coat hypertension, which means that your blood pressure spikes in your doctors office but returns to normal elsewhere. For example, your reading may be high when you have a physical and normal when you use the device at your pharmacist or grocery store .
Lets look at the numbers. The American Heart Association provides the measurements that you should aim for, as well as the ranges that put you in the danger zone. All measurements are mm Hg.
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Physical Activity And Sports
|How much activity is needed to lower my blood pressure?|
To lower your blood pressure, aim to do at least 30 minutes of moderate activity five times a week. Moderate activity is activity that gets you slightly warm and out of breath, but you should still be able to have a conversation brisk walking, swimming, cycling and gardening for example.
If you are starting from scratch, or you have other medical conditions, you may need to build up to this level gradually. You can break your session up into 15 minutes twice a day or ten minutes three times a day.
What Foods Help Lower Blood Pressure
If your blood pressure reads consistently higher than 130/80 when you are in a lying down position, you are considered to have high blood pressure.
While limiting alcohol consumption and avoiding smoking are the best ways to lower blood pressure, changes to your diet are important as well. Below are examples of foods that can help you bring your blood pressure under control:
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What Are The Gaps In The Knowledge
Future studies, which should obtain more precise answers to the problem, should include IHD patients with a known coronary anatomy, the type and completeness of revascularization, and the known extent of myocardial ischemia . One of the aims should be to find a way to reduce sBP to within the target range, and to then optimize dBP because a risk remains after the target sBP has been achieved. An analysis of the types and combinations of antihypertensive drugs related to lowered dBP and the MACE rate is also warranted. Bearing in mind that sBP influences the prognosis the most, it is very important to determine whether, apart from the sBP, the dBP level influences the prognosis more than the class of antihypertensive drugs used, or vice versa.
Simultaneous recordings of Holter ECG and ABPM would give us a more precise insight into the direct provoking mechanisms involved. It would also be useful to see the influence of contemporary IHD management on the J-curve relation between dBP and mortality in patients with both IHD and SH. Sufficiently large trials are also needed to investigate the J-curve in patients > 60 years of age with SH, with or without LVH and IHD.
Are There Warning Signs Days Before A Stroke
Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology.
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Risk Factors For Low Blood Pressure
If youre older than 65, you may be at risk of orthostatic hypotension, a condition in which your blood pressure drops when you move from sitting to standing. Endocrine problems, neurological diseases, heart problems, heart failure, and anemia may also cause the condition.
You may also be at risk for low blood pressure if you become dehydrated or take certain prescription drugs such as:
A range of treatments are available for high or low blood pressure.
What Do The Numbers Mean
So, what exactly do those numbers mean? Lets start with systolic blood pressure. This is the force that is generated within the arteries when the heart contracts . This, along with diastolic, is measured in millimeters of mercury .
Diastolic pressure is the pressure on the arteries between heartbeats, or in other words, when the heart is in the relaxed state. The systolic pressure is the higher number, which is on top, and diastolic is the lower number. An ideal reading would be 120 over 80.
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What Is Diastolic Blood Pressure
The heart rests between beats so it can refill with blood. Doctors call this pause between beats “diastole.” Your diastolic blood pressure is the measurement during this pause before the next heartbeat.
A normal diastolic blood pressure during quiet rest is 80 mmHg or a little below. If you have high blood pressure, the diastolic number is often higher even during quiet rest.
Low diastolic pressure may be seen with dehydration or with severe bleeding. It also may happen if the arteries relax and widen.
Why Diastolic Blood Pressure Is Important
Typically, for people over 50, more attention is directed to the higher number, systolic blood pressure, as a major risk factor for cardiovascular disease 4. Therefore, why is diastolic pressure important?
Diastolic pressure is important because an elevated diastolic pressure may be used to make a diagnosis of high blood pressure. In addition, elevated diastolic pressure means there is an increased risk of developing elevated systolic blood pressure as a person ages.
Recent studies have researched people ranging from 40 to 89 years of age. They found for each 10 mmHg diastolic number increase in blood pressure, the risk of death from ischemic heart disease and stroke doubles.
Ischemic heart disease is a term given to heart problems that are caused by narrowed heart arteries.
On the other hand, if diastolic blood pressure is too low, meaning coronary arteries arent getting enough blood pressure, the heart is going to lack oxygen and blood. This is called ischemia and may weaken the heart over time which can lead to heart failure.
The coronary arteries which surround the aortic valve in the heart only get blood when the aortic valve closes, and this happens in diastole 5.
What is diastole? Diastole is the part of the cardiac cycle when the heart is relaxed between beats and refills with blood.
Diastolic blood pressure is measured at the moment diastole is occurring 6.
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Healthy And Unhealthy Blood Pressure Ranges
Learn whats considered normal, as recommended by the American Heart Association.
|SYSTOLIC mm Hg||and/or||DIASTOLIC mm Hg|
|HIGH BLOOD PRESSURE STAGE 1||130 139|
|HIGH BLOOD PRESSURE STAGE 2||140 OR HIGHER|
|HYPERTENSIVE CRISIS||HIGHER THAN 180||and/or||HIGHER THAN 120|
Note: A diagnosis of high blood pressure must be confirmed with a medical professional. A doctor should also evaluate any unusually low blood pressure readings.
What Will Doctor Do For High Blood Pressure
High blood pressure treatment Additionally, your doctor may prescribe medicine to lower your blood pressure. These are called antihypertensive medicines. The goal of treatment is to reduce your blood pressure to normal levels. Your doctor may prescribe medicine thats easy to take and has few, if any, side effects.
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High Blood Pressure: The First Number Vs The Second Number
Oct. 1, 1999 — 120/95. 190/80. 180/110. Many patients have wondered, when they get their blood pressure taken, which is the most important number: the first, higher number , or the second, lower number ? A recent study showed that the systolic number is at least as important as the diastolic number, a finding which is somewhat contrary to traditional belief. To get the word out, the National High Blood Pressure Education Program, coordinated by the National Heart, Lung and Blood Institute , will be issuing, later this fall, a clinical advisory letter to U.S. health professionals warning of the danger of not properly treating high systolic blood pressure.
The systolic reading measures pressure in the blood vessels during that split-second when the heart is pumping out blood the diastolic reading measures pressure when the heart is at rest. Up until recently, many in the medical community have emphasized the diastolic reading, but an accumulation of recent findings shows that the systolic reading is as — if not more — important in diagnosing and treating high blood pressure, or hypertension.
Patients are classified into blood pressure stages depending on their reading and treated accordingly. The stages, as outlined by the sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure , range from normal and high normal to stage 1, 2, 3 hypertension. The guidelines were updated in 1997.
Which Blood Pressure Number Is Important
Q.When I am monitoring my blood pressure, which number is most important top, bottom, or both?
A. While both numbers in a blood pressure reading are essential for diagnosing and treating high blood pressure, doctors primarily focus on the top number, also known as systolic pressure.
Systolic pressure reflects the force produced by the heart when it pumps blood out to the body, while diastolic blood pressure is the pressure in your blood vessels when the heart is at rest.
Over the years, research has found that both numbers are equally important in monitoring heart health. However, most studies show a greater risk of stroke and heart disease related to higher systolic pressures compared with elevated diastolic pressures. That’s especially true in people ages 50 and older, which is why doctors tend to monitor the top number more closely. The reason for the difference in risk may be related to the force put on the arteries when blood rushes out of the heart.
The American Heart Association now defines high blood pressure as 130/80 mm Hg or higher. The new guidelines recommend you check your blood pressure often, ideally with a home monitor, to help your doctor determine if you need to make lifestyle changes, begin medication, or alter your current therapy.
by Howard LeWine, M.D.
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Systolic High Blood Pressure
If you have high systolic blood pressure, there is a lot of pressure on the arteries inner walls, which can lead to permanent damage. Not only does this cause heart problems, it can also lead to problems with other organs.
This is because the damage caused by this type of high blood pressure causes plaque to accumulate in the artery walls, which inhibits the flow of blood to the other organs, including the brain. This causes an increased risk of the rupturing of the plaque, causing a clot which can be deadly. This type of high blood pressure can lead to heart attacks and strokes, and as noted, can damage other organs.
The systolic reading, or the upper numbers, is the one that is most associated with heart disease. But, when it comes to your health, you really do need to pay attention to both numbers.
Even if your blood pressure is only elevated a little bit, it can get worse and lead to some pretty serious health issues. But, you can lower your blood pressure with diet and exercise. In some cases, it may require medical intervention in the form of blood pressure medication.
Systolic Vs Diastolic Blood Pressure
For many of us, blood pressure is merely the reading our doctor takes at the beginning of our annual physical. The two numbers they mention only attract concern if theyre paired with a worried expression. But understanding more about these numbers can help you avoid bigger health issues down the road.
If you’ve always wondered what these numbers mean or suddenly found yourself concerned with a diagnosis of high blood pressure , youve come to the right place.
Heres a quick run through of what those numbers mean and which you should be more concerned about.
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What Factors Affect Your Diastolic Pressure
The factors discussed are heart rate, arterial pressure, coronary perfusion pressure, the pericardium, and the mechanical interplay between ventricles. The influence of heart rate, arterial pressure, and coronary perfusion pressure can be considered as minor provided they remain within their normal physiological range.
What Are The Sounds Heard While Taking A Blood Pressure
If the pressure is dropped to a level equal to that of the patients systolic blood pressure, the first Korotkoff sound will be heard. As the pressure in the cuff is the same as the pressure produced by the heart, some blood will be able to pass through the upper arm when the pressure in the artery rises during systole.
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