For people over 50 or so, high systolic numbers are more closely connected with heart attacks and strokes. And "isolated systolic hypertension" (say, 155/80), with its wide pulse pressure, is especially risky.
As pal7778 pointed out, it's age related. For a 30 year old, the diastolic is far more important but then diastolic drops a lot with age and systolic comes to the fore.
I think that high systolic is reading stiffening of the arteries with age and stiffening implies risk from plaque and "hardening." I feel strongly that the BP is often more an EFFECT of the stifffening rather than the cause and thus I feel that lowering systolic with drugs will not do much to prevent a heart attack. The medical profession seems to feel otherwise...I think their evidence is weak!
Do you know that before the 1950's a "good" systolic was defined as your age + 100. Just read that in an old Principles of Internal Medicine!
That cause/effect point is interesting. High blood pressure is correlated with this and that, but that doesn't mean that just reducing blood pressure will reduce your risk, esp. for a heart attack (because the high blood pressure is the result of a problem that
reducing the bp will not solve). The situation is different when it comes to the effect of hbp on the heart directly or on the kidneys.
Many sins have been committed in the name of CAUSE AND EFFECT.
So many people die of heart attacks while shovelling snow but snow is not a cause of heart attacks!
I have no problem with the EXTREME danger to the kidneys from a high diastolic ...which after all, is the LOWEST pressure the kidney ever sees, so it's CONTINUOUS and unremitting. And I have no problem with the cause and effect of stroke and very high systolic because an aneurism (even sub-clinical size) will burst only at the HIGH point of the BP wave pulse. But then there's the issue of would an artery burst without a process that first weakened it and what did that? BP maybe, maybe not. Was it necessary for flexibility of the cerebral arteries to be first compromised, after all, teeny-boppers with supple arteries don't have strokes?
Just some personal gut feelings.
An image just shot through my head: An honest doctor sees a patient (for $125) who presents with a 150 systolic.
"You know, a high systolic is associated with stiffened arteries which occurs with age and is a probable cause of heart attacks."
I asked my doctor whether systolic, diastolic or pulse presssure was more important. She told me systolic and diastolic were equally important, and she didn't think much of the pulse pressure.
I agree. It makes sense that it is important to get both systolic and diastolic readings under control. I certainly don't want to see a high reading for either one. Over time, high blood pressure can cause irreversible damage to vital organs.
No one wants constant unhealthful pressure (diastolic) on all of their organs, throughout their body for long periods of time, and no one certainly wants their peak blood pressure (systolic) to be too high for long periods of time.
Many of the current meds target the neuro-hormonal system in an attempt to prevent hormones from constricting blood vessels, which in turn is one of the major causes of Primary high blood pressure.