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July 19, 2019

Diastolic numbers are as important as systolic are, find why

Blood pressure measurements are given as a "top" and "bottom" number. The first reflects systolic blood pressure, the amount of pressure in the arteries as the heart contracts. The second reflects diastolic blood pressure, the pressure in the arteries between heart muscle contractions.

For years, systolic blood pressure has been seen as the one that really matters. That's based on studies -- including the famous Framingham Heart Study -- showing that high systolic blood pressure is a stronger predictor of heart disease and stroke.

At the same time, though, doctors measure both systolic and diastolic blood pressure, and treatment guidelines are based on both. So just how important is that diastolic number?

"The idea behind this new study was to address the confusion," said lead researcher Dr. Alexander Flint, an investigator with Kaiser Permanente Northern California's division of research.

Using medical records from 1.3 million patients, his team confirmed that, yes, high systolic blood pressure was a stronger risk factor for heart attack and stroke. But those risks also climbed in tandem with diastolic pressure; and people with normal systolic readings were still at risk if their diastolic pressure was high.

"There's been a common belief that systolic blood pressure is the only one that matters," Flint said. "But diastolic definitely matters."

He and his colleagues reported the findings in the July 18 issue of the New England Journal of Medicine.

The definition of high blood pressure has gotten a revamp in recent years. Guidelines issued in 2017 by the American College of Cardiology (ACC) and other heart groups lowered the threshold for diagnosing the condition -- from the traditional 140/90 mm Hg to 130/80.

The fact that treatment guidelines include a diastolic pressure threshold implies that it's important. And indeed it is, said Dr. Karol Watson, a member of the ACC's prevention section and leadership council.

In fact, she said, doctors once thought that diastolic blood pressure was the more important one -- based on research at the time. Then came the studies showing that systolic pressure was generally a better predictor of people's risk of heart disease and stroke.

In addition, Watson said, high systolic blood pressure is more prevalent, because of natural changes in blood pressure as people age.

"As we get older, systolic blood pressure keeps marching up," she explained. Diastolic blood pressure, on the other hand, generally peaks when people are in their 40s to 60s -- and then it declines.

But it's clear, Watson said, that while systolic and diastolic blood pressure are different, they both deserve attention.

In the latest study, cardiovascular risks rose with each "unit increase" in systolic pressure above 140, by about 18% on average. Meanwhile, each increase in diastolic blood pressure above 90 was tied to a 6% increase in heart disease and stroke risk.

The researchers saw a similar pattern when they looked at blood pressure increases above the 130/80 threshold. That, Flint said, supports the 2017 guideline shift.

The findings are based on over 1.3 million patients in the Kaiser Permanente health system who had roughly 36.8 million blood pressure readings taken from 2007 through 2016. Over eight years, more than 44,000 patients had a heart attack or stroke.

According to Flint, it's the largest study of its kind to date.

The bottom line for patients, Watson said, is that they should care about both blood pressure numbers. In her experience, she noted, patients often point to the number that's in the normal range and say, "But look how good this is."

Flint agreed, saying that no one should "ignore" the diastolic number. "It's important not only in blood pressure treatment, but on the side of diagnosis, too," he said.

June 11, 2019

Just three things could save 94 million people from heart disease

Image courtesy of Stuart Miles at
These three things could save 94 million people from heart disease.
In a new study, researchers found that three public health interventions could save 94 million people from premature death caused by heart disease.
The three interventions are lowering blood pressure, cutting sodium intake, and reducing trans fat from the daily diet.
They suggest that the three interventions can have a huge health impact on heart health through 2040.
The research was led by Harvard T.H. Chan School of Public Health.
In the study, the team used global data from multiple studies and estimates from the World Health Organization to make their calculations.
They estimated that scaling up treatment of high blood pressure to 70% of the world’s population could extend the lives of 39.4 million people.
In addition, cutting sodium intake by 30% could stave off another 40 million deaths and could also help reduce high blood pressure, which a major risk factor for heart disease and stroke.
Eliminating trans fat could prevent 14.8 million early deaths.
The team also found that more than 50% of all delayed deaths, and 66% of deaths delayed before age 70, will be among men.
They suggest that many programs and policies would be necessary to reduce premature deaths from heart disease.
For example, one important strategy would be to increase the use of blood pressure drugs that are safe and affordable.
The team admits that scaling up the three health interventions would be a “huge challenge,” but they added that previous analyses have shown that the interventions are achievable and affordable.
They believe that these are realistic goals that have been shown to be attainable on a smaller population.
Now people need the commitment to scale up the programs to achieve them globally.
The lead author of the study is Goodarz Danaei, associate professor of global health at Harvard Chan School.
The study is published in Circulation.

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