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High Blood Pressure

Which B/P reading should be more of a concern

12/27/2004

Question:

For a 68 year old which B/P reading should be more of a concern and why? 134/95 or 138/75.

Answer:

Both blood pressure readings that you quote are acceptable for an otherwise healthy person.  However, the significance of the systolic and diastolic blood pressures (the upper and the lower number) differ, and the difference between the two (the so-called pulse pressure) is also important:

It has been shown that for anyone over age 50, the higher the pulse pressure, the greater the risk for heart disease and stroke.  An ideal pulse pressure should be 50 or less. In your example, with a blood pressure of 134/95, the pulse pressure is 39, while with a blood pressure of 138/75 it is 63 .  Therefore, the first blood pressure carries a lower risk than the second.

With blood pressure measurements, the pulse pressure is important, because it correlates best with biological ageing and hardening of the arteries.  In a person over age 50, at any given systolic pressure, the LOWER the diastolic pressure the greater the risk, because it signifies a higher pulse pressure.  However, the pulse pressure cannot be changed quickly with treatment.  For that reason, it is adequate in most cases to lower the systolic blood pressure to goal (below 140 for otherwise healthy individuals, below 130 for people with diabetes and/or kidney disease).

There is a strong association between systolic pressure and cardiovascular risk.  Again, a systolic pressure of 134 is better than a systolic pressure of 138.

The significance of the pulse pressure in people under age 50 is less clear, and many physicians would treat a high diastolic pressure even if the systolic is not elevated.  Such cases are quite rare, however.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati