A recent post of ZUZU's got me thinking about this subject so I thought I'd open a discussion on which is/should be more important.
Systolic is the highest instantaneous pressure that the heartbeat can generate in the largest arteries of the body; diastolic is the lowest that the pressure drops between the systole peaks. If you look at a graph of pressure you see that most of the graph is far closer to the diastolic than the systolic.
So in the past, the consensus was that contol of diastolic was the best standard for good blood pressure management (and judgement about WHETHER to mange at all.)
In recent years, emphasis has been put more and more on SYSTOLIC pressure. The logic is that a STROKE or blown artery, which is probably the most devastating event that BP can generate would occur only at a SYSTOLE, i.e., a hose will burst at it's HIGHEST pressure, not its lowest.
Little by little I think I am spotting a revival of interest in the diastolic as the more important. These swings can make us patients a bit dizzy, eh wot?
Another concept that has reared its head in the last decade is "PULSE PRESSURE" defined as the difference between systolic and diastolic. It is thought to be a measurement of arterial "stiffness" and may be related to the amount of plaque and calcification that had "hardened" the arterial walls. (Any oldies might remember the term "hardeniing of the arteries" which was loosely tossed around to mean everything from heart disease to senility.) Of course a high systolic has the most impact on amplifying this "stiffness."
Here's my take on the matter, which probably differs from some current norms. I think that diastolic control is very important because, it's the ENDLESS, unremitting pressure on the delicate tubules in the kidney that is a very dangerous aspect of blood pressure. It's also the one aspect of blood pressure that is self perpetuating, i.e., hypertension>>kidney damage>>hypertension.
The pulse pressure, while an interesting phenomenon indicating likely vascular damage, is only illustrative. Controlling pulse pressure (basically, systolic control) won't reverse the arterial damage or the actual "stiffness" just the ability to notice it readily...like painting your speedometer black won't make the car go slower, just your ability to determine the speed.
Of course, nobody could deny the huge stroke risk of a systolic over 200, but using a handful of drugs to get a 145 or 150 down to 135 might not be as wise as some practitioners think. There seems to be some evidence that lowering diastolic (inevitable with these drugs) below 80, or even 82 if I remember correctly, shows a detrimental effect on life expectancy (J-curve phenomenon).
How do you feel about the subject of systolic/diastolic? Any interesting study results you've seen? Anything anecdotal?
I had a routine followup visit for my hypertension just this past Tuesday. I have "white coat", but my pressure was pretty good, 127/87. (The doctor had relocated to a new building, maybe my office pressure will be lower now, lol!) At home I average around 116/65, but sometimes a lot lower, and I told her that. She told me something that confused me, she said, "Just try to keep it below 130/85 for a resting rate most of the time." At home I am almost always much lower than that for a resting reading. This makes me wonder if I am over medicated.
I specifically asked what was current thinking, systolic or diastolic more important, and I asked about pulse pressure. She said pulse pressure was an old outdated concept and that neither systolic or diastolic were more important - if either one of them was too high then that was a problem.
I like my doctor and I think she is pretty sharp and current with the literature. I'm not putting her words out as gospel, but that is what I was told.
I guess I should add that she was probably talking about normal people like me without underlying medical conditions beyond hpertension.
I don't think that any of the GP's know what is what. They keep changing their minds. They keep changing the guidelines & GP's have a reduced role in today's society. If everyone with high readings at the doc. took b/p meds. 50% of the population would be zombies. I am going to a specialist to see if they have some knowledge. I am tired of having more knowledge about B/P than my GP. Anything under 130/85 is alright??? I thought that 115/75 were the new guidelines? Numbers are just numbers.....unless you are like 190/110.
) At home I average around 116/65, but sometimes a lot lower, and I told her that. She told me something that confused me, she said, "Just try to keep it below 130/85 for a resting rate most of the time." At home I am almost always much lower than that for a resting reading. This makes me wonder if I am over medicated.
A. CAN I HAVE YOUR DOCTOR...PLEASE PLEASE! How logical she is, saying that aiming for 130/85 is good control.
B. More seriously, if I were you, getting a consistent 116/65 at home, I would definitely cut my dosage starting with the meds that are most bothersome; if none are, then I'd cut the most expensive (usually the ARB or the Norvasc)
If I average 112-116 over 62-68 with a pulse rate of 52-58 on 100 MGS of Atenolol & 5/20 of Lotrel would you advise me to do the same thing??? I'm only 34, 5' 11" 150 & have had bad side effects ever since being on the meds, especially the Atenolol. I am going to a specialist on my own freewill, because GP's don't seem to understand BP (at least the 3 that I have gone to). I can get readings like 156/86 at the GP, but never ever outside of the G/P. I have 300 readings over 2 years to prove it. I have white-coat & anxiety.
I'm thinking about cutting back on one of them. I take tiazac (cardizem a calcium channel blocker) at 180mg which I think is its lowest dosage. It is a capsule, so I can't cut it. The other is clonidine at .1mg 3 times a day. I'm thinking of going to twice a day on that one. I did that a couple of times on weekends with no problem. I tried today to wait 12 hours after my nightime dose, but had to take it after 11 hours due to some withdrawal symptoms. Either that or it could have been hormonal. Clonidine helps those symptoms too. After taking the .1mg later than normal, my blood pressure and pulse have been higher than normal today. I just took my bp, 144/81 pulse 92. Pulse today has ranged from 71 to 117 resting. On this drug combo resting pulse is usually in the 60s. Guess I go back to 3 times a day today.
I'm getting 112-116 over 62-66 on Lotrel 5/20 and Atenolol 100 MGS with a pulse rate of 52-58. I feel like junk with all of the side-effects & after I see the specialist on 2/16, I better be weaned off of these meds. or put on a small dose of something with no side-effects. 2 years is enough...
Personally, I wouldn't medicate my diastolic into the 60's. There simply is no good reason to do so. I'm almost certain it does more harm than good.
You have to decide whether your doctors are in charge or you're in charge. After that HARD decision all the rest are easy.
My, that clonidine seems to be quite the addictive little bugger! I think many people who ake it like to take it at night because it's something of a sleep inducer. It's one of the few I've never taken so I don't know much about it. I wouldn't worry too much about the rebound pulse rate...I'm sure it's temporary (and I KNOW it uses calories)
Re: systolic vs diastolic and pulse pressure, there are some doozy articles I found that cost 45 smackeroos to access...(More than 3 month's supply of my Diovan!).
A lot of articles I DID manage to read, refer to the Framingham study conclusions that with increasing age...
"...there was a gradual shift from DBP to SBP and then to PP as predictors of CHD risk. In patients <50 years of age, DBP was the strongest predictor. Age 50 to 59 years was a transition period when all 3 BP indexes were comparable predictors, and from 60 years of age on, DBP was negatively related to CHD risk so that PP became superior to SBP."
From Circulation 2001. Interesting info about half way down on the hemodynamic mechanisms of risk:
That last sentence from the ABSTRACT is a doozy:
When both SBP and DBP were considered jointly, the former was directly and the latter was inversely related to CHD risk in the oldest age group
It really DOES say that the higher the diastolic the better in the elderly.
Anyways, the gist is that the older we get the more a high pulse pressure indicates a cardiac risk. But INDICATES is the operative word. What is INDICATED is arterial damage and all the BP lowering in the world isn't likely to make it better; the high Systolic and pulse pressures are EFFECTS rather than CAUSES.
An analogy: an itchy rash is indicative of second stage syphilis, but the benadryl or cortisone that makes the rash stop itching won't prolong life or alter the course of the disease.
p.s, Now HOW in blue blazes to they hope to manage a treatment for the elderly that LOWERS systolic but raises diastolic. I guess in the real world, they DON'T! Replace the vascular system I guess.