Doctors Urged To Shift Focus To `High' Blood Pressure Number

By Jeff Nesmith, New York Times Syndicate

"You get more bang for the buck by lowering the systolic blood pressure."

The top number in your next blood pressure check is more important than you — and possibly your doctor — realize in predicting whether you will have a heart attack or a stroke, experts said Thursday.

Because they were trained to believe the lower number is more important, many doctors fail to pay enough attention to the upper measurement, said members of the coordinating committee of the National High Blood Pressure Education Program.

The committee's recommendation that doctors give priority to the higher number, systolic blood pressure, becomes the official recommendation of the National Heart, Lung and Blood Institute.

While not an outright reversal of standard medical practice, the committee acknowledged that the change in emphasis represents a ``major paradigm shift."

In a person with ideal blood pressure - 120 over 80 or lower - systolic pressure is a measurement of the pressure the blood exerts on blood vessel walls when the heart is beating.

The lower number is for diastolic pressure, the pressure between beats.

Any time a patient's systolic pressure rises above 140, steps should be taken to lower it, the panel said, even if diastolic pressure appears to be within acceptable limits.

Hypertension treatment may consist of exercise and diet changes. In more severe cases, patients may need medication.

"Based on the wealth of currently available evidence, the committee now recommends a major paradigm shift in urging that systolic blood pressure become the major criteria" in treating hypertension, the panel said.

Dr. Joseph L. Izzo, a Buffalo clinician and professor at State University of New York at Buffalo, said in a telephone interview that doctors have been trained to believe that diastolic blood pressure is more important in assessing a patient's risk of a heart attack, congestive heart failure, stroke or kidney damage.

"We have been training that view for years," he said. "We have been saying systolic pressure inevitably rises with age and is not as significant as diastolic pressure. And doctors have been saying that it's okay for systolic to go up if diastolic is down."

In fact, he said, "you get more bang for the buck by lowering the systolic blood pressure."

An estimated 50 million Americans have high blood pressure, often called the "silent killer" because it is a deadly disease, leading to stiffening and thickening of the arterial walls and then to heart disease and stroke.

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