Last Updated: 2008-06-17 12:25:04 -0400 (Reuters Health)

NEW YORK (Reuters Health) – Because the prevalence of systolic hypertension continues to rise with age, while diastolic hypertension virtually disappears, clinicians should focus solely on systolic blood pressure in patients over 50 years old, experts advise in the June 17th online issue of The Lancet.

In people under 40, up to 40% of the hypertension seen is diastolic, the report indicates. From age 40 to 50, diastolic hypertension accounts for about 33% of hypertension. After age 50, however, diastolic hypertension is largely replaced by systolic hypertension.

"Since more than 75% of people with hypertension are aged over 50 years, the burden of disease is mainly due to systolic pressure," write Bryan Williams of the University of Leicester, Peter Sever of Imperial College London and Lars Lindholm of Sweden’s Umea University Hospital. "The use of diastolic pressure for diagnosis and risk analysis in our ageing populations has thus become illogical."

The authors, who are attending the International Society of Hypertension meeting this week in Berlin, cite four reasons why only systolic pressure should be measured in this age group:

–Measuring systolic pressure is easier than measuring diastolic pressure and is a better predictor of cardiovascular risk.

–Being able to relate one number to patients instead of two could simplify doctor-patient communications.

–Using just the systolic pressure could help clarify the conflicting messages clinicians have received about systolic and diastolic pressure.

–Focusing a public health campaign on just one number could markedly improve outcomes for patients with systolic hypertension and reduce the associated morbidity.

In patients under 50, consideration of both systolic and diastolic pressure is warranted, the authors note. "However, this much smaller group of patients should not dilute the key message regarding the overwhelming importance of systolic blood pressure for most patients with hypertension."

Moreover, the authors state that even if systolic pressure was to become the focus in younger patients, this would likely lead to improvements in both systolic and diastolic pressures. By contrast, using diastolic pressure as the sole treatment target would leave many at risk patients with uncontrolled systolic pressure.

Lancet 2008.

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