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Systolic, Not Diastolic, Blood Pressure Has More Impact On Staging

Systolic blood pressure has more impact on blood pressure staging and imposes a greater burden on the community than does diastolic blood pressure.

The differential impact of systolic and diastolic blood pressures on blood pressure burden and staging is favourable to systolic blood pressure only among people older than 50 years.

These findings, among Spaniards aged 35-64 years, agree with recent guidelines on hypertension management, say specialists in preventive medicine and public health in Madrid, Spain. They pointed out that systolic blood pressure is a cardiovascular risk factor more often than diastolic blood pressure and had more impact on blood pressure staging, although that could vary with age, sex and country. This led the researchers to undertake a cross-sectional study of a representative sample of Spain's middle-aged population.

Blood pressure was determined under standardised conditions. It was classified according to World Health Organization-International Society of Hypertension (WHO-ISH) and Joint National Committee-VI (JNC-VI) criteria. The prevalence of systolic blood pressure above 139 mmHg was 34.1 percent and of diastolic blood pressure above 89 mmHg was 30.9 percent.

Of those studied, 12.0 percent had isolated systolic hypertension and 8.7 percent had isolated diastolic hypertension. Of treated hypertensives, 31.0 percent had their systolic blood pressure controlled and 34.0 percent had their diastolic blood pressure controlled.

Of those not receiving antihypertensive drugs, 60.8 percent had congruent systolic blood pressure and diastolic blood pressure levels, 22.5 percent were up-staged on the basis of their systolic blood pressure and 16.7 percent were up-staged on the basis of their diastolic blood pressure.

Systolic blood pressure alone thus correctly classified JNC-VI staging in 83.3 percent of subjects versus 77.5 percent for diastolic blood pressure alone.

It was solely among both men and women older than 50 years that systolic hypertension proved more frequent than diastolic hypertension. Likewise, it was only in those older than 50 years that the prevalence of isolated systolic hypertension exceeded that of isolated diastolic hypertension.

Similarly, only in those older than 50 years was systolic blood pressure worse than diastolic blood pressure control and the percentage of systolic blood pressure higher than that of diastolic blood pressure up-staged people.
Journal of Human Hypertension 2002; 16:163-167. "Systolic vs diastolic blood pressure: community burden and impact on blood pressure staging"

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