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Tuesday, September 30, 2014
High Blood Pressure
Isolated Diastolic Hypertension
I am a 52 yr old male with a normal Systolic reading, but elevated Diastolic (usually in the 90`s) and no other health problems. I`ve seen fairly recent studies that say hypertension at this age should be determined by the systolic reading and not diastolic. And that the mortality rate is no higher for someone with elevated diastolic in this range than it is if they had normal diastolic. So how crucial would it be that someone my age starts medication for only elevated diastolic, or is this still debatable among doctors? Thank you
You are right that the systolic blood pressure correlates much better with the risk for heart disease and stroke than the diastolic blood pressure. In the case of the systolic blood pressure, the relationship is straightforward: The higher the pressure, the greater the risk. The current guidelines recommend a systolic blood pressure of no higher than 140 for most people. Higher levels should be treated. The case is more complicated for diastolic blood pressure. In younger people (under age 50), a high diastolic (level above 90)also carries some risk, but in people over age 50, the relationship changes, and a high diastolic is less important. In that age group, it is the difference between the systolic and diastolic blood pressure (called the pulse pressure) that starts to matter. The bigger the pulse pressure, the greater the risk. This means that, at a given systolic pressure, a low diastolic is worse than a high diastolic pressure, because it represents a larger pulse pressure. As long as your systolic pressure stays below 140 (preferably below 130), your blood pressure does not require treatment. Some researchers propose that a high diastolic pressure is actually a sign of good vascular health, as long as the systolic stays within normal range. Although current guidelines still propose treatment of an elevated diastolic blood pressure, most experts agree that in people over age 50 it is not necessary.
Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati