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Systolic Blood Pressure Key for Elderly.

Blood pressure is typically recorded as two numbers--the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats), in the past, many physicians relied on diastolic blood pressure to diagnose hypertension. However, research has found that diastolic blood pressure rises until about age 55 and then declines, while systolic blood pressure increases steadily with age.

"Systolic hypertension is a major health threat, especially for older Americans," cautions Claude Lenfant, director of the National Heart, Lung, and Blood Institute (NHLBI). "While it cannot be cured, systolic hypertension can be treated and its complications prevented. Americans may have heard that diastolic blood pressure counts more. That may be true for younger people. But we now know that, as people get older, systolic blood pressure becomes more important.... If you're middle-aged or older, it's a better blood pressure indicator than diastolic of your risk of heart disease and stroke."

Findings from NHLBI's long-term Framingham Heart Study of 5,000 persons showed that systolic blood pressure alone correctly identified 91% of those who may need antihypertensive therapy, while diastolic blood pressure alone correctly identified 22% of them. Among those over age 60, systolic blood pressure alone was even better able than diastolic pressure alone to classify blood pressure correctly.

For many older Americans, only the systolic blood pressure is high, a condition known as isolated systolic hypertension, or ISH (systolic at or above 140 and diastolic under 90). ISH is the most common form of high blood pressure, affecting 65% of all hypertensives over age 60.

According to an advisory by the National High Blood Pressure Education Program, that is the same group that has the poorest hypertension control rate. This is "primarily as a result of inadequate systolic blood pressure control." For example, in hypertensives over age 70, just 25% of African-Americans and 18% of whites have their blood pressure under control to below 140-90.

The advisory emphasizes that research, including results from clinical trials, has proved that controlling ISH significantly reduces heart attack, heart failure, and stroke. The advisory recommends reducing systolic blood pressure to less than 140. It cites diuretics as a first-line treatment for ISH. Other recommendations in the advisory are:

* Blood pressure at all ages should be maintained at or below 140/90.

* Treatment for hypertension must begin early to prevent organ damage, whatever the patient's age.

* In hypertensives with diabetes, blood pressure should be kept below 130/85; in those with renal or heart failure, at the lowest level tolerated.

* Blood pressure should be reduced carefully in elderly persons with longstanding severe systolic hypertension. Blood pressure goals for resistant patients may take longer to reach.
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Publication:USA Today (Magazine)
Article Type:Brief Article
Geographic Code:1USA
Date:Oct 1, 2000
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