Background: The relationship between outpatient systolic and diastolic blood pressure and cardiovascular outcomes remains unclear and has been complicated by recently revised guidelines with two different thresholds (≥140/90 mm Hg and ≥130/80 mm Hg) for treating hypertension. Show
Methods: Using data from 1.3 million adults in a general outpatient population, we performed a multivariable Cox survival analysis to determine the effect of the burden of systolic and diastolic hypertension on a composite outcome of myocardial infarction, ischemic stroke, or hemorrhagic stroke over a period of 8 years. The analysis controlled for demographic characteristics and coexisting conditions. Results: The burdens of systolic and diastolic hypertension each independently predicted adverse outcomes. In survival models, a continuous burden of systolic hypertension (≥140 mm Hg; hazard ratio per unit increase in z score, 1.18; 95% confidence interval [CI], 1.17 to 1.18) and diastolic hypertension (≥90 mm Hg; hazard ratio per unit increase in z score, 1.06; 95% CI, 1.06 to 1.07) independently predicted the composite outcome. Similar results were observed with the lower threshold of hypertension (≥130/80 mm Hg) and with systolic and diastolic blood pressures used as predictors without hypertension thresholds. A J-curve relation between diastolic blood pressure and outcomes was seen that was explained at least in part by age and other covariates and by a higher effect of systolic hypertension among persons in the lowest quartile of diastolic blood pressure. Conclusions: Although systolic blood-pressure elevation had a greater effect on outcomes, both systolic and diastolic hypertension independently influenced the risk of adverse cardiovascular events, regardless of the definition of hypertension (≥140/90 mm Hg or ≥130/80 mm Hg). (Funded by the Kaiser Permanente Northern California Community Benefit Program.).
[Article in Italian] Affiliations
Review [Systolic, diastolic and pulse pressure: pathophysiology][Article in Italian] G de Simone et al. Ital Heart J Suppl. 2001 Apr. AbstractArterial hypertension is the result of abnormal flow/resistance relationships. Resistance to outflow consists of different components: the systolic component is the one generated by conductance vessels, whereas the diastolic component consists of peripheral resistance, which regulates peripheral blood supply due to the run-off of conductance vessels during left ventricular diastole. Thus, an increase in systemic resistance results in a rise in diastolic blood pressure. If the elasticity of conductance vessels decreases, diastolic run-off also decreases and diastolic blood pressure goes down. When this loss of elasticity occurs, the ejection force cannot be anymore offset by arterial distension, the pulse wave velocity increases and reflex waves to the heart arrive earlier, causing the systolic blood pressure to augment. Such an augmentation, together with decreasing diastolic blood pressure results in an enhancement of the pulse pressure. When the stroke volume is normal, an increase in pulse pressure is, therefore, a marker of altered conductance. However, if, due to loss of elasticity of the conductance arteries diastolic blood pressure goes down, increasing systolic pressure also protects against a decrease in mean pressure. Indeed, in conditions of elevated pulse pressure, the mean pressure can be normal or high, indicating that when evaluating blood pressure all components should be taken into consideration. A high systolic blood pressure associated with a normal mean blood pressure is suggestive of a normal peripheral resistance. In this context, isolated systolic hypertension can be conveniently divided into a normal peripheral resistance type, and into a high peripheral resistance type when it is associated with high values of mean blood pressure (independently of whether or not the diastolic blood pressure is increased). In this latter occurrence, a high pulse pressure is more likely to be a marker of severe target organ damage (conductance arteries) than of a direct causal risk factor such as systolic blood pressure. Similar articles
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How much difference should there be between systolic and diastolic?The top number (systolic) minus the bottom number (diastolic) is the pulse pressure. For example, if the resting blood pressure is 120/80 millimeters of mercury (mm Hg), the pulse pressure is 40 — which is considered a healthy pulse pressure. Generally, a pulse pressure greater than 40 mm Hg is unhealthy.
What does a narrow pulse pressure mean?A narrow pulse pressure — sometimes called a low pulse pressure — is where your pulse pressure is one-fourth or less of your systolic pressure (the top number). This happens when your heart isn't pumping enough blood, which is seen in heart failure and certain heart valve diseases.
What does systolic and diastolic depend on?Your systolic and diastolic pressures—the highest and lowest points of your heartbeat—change depending on your activity level, stress, fluid intake, and other factors. You need to do your best to limit how these other factors might change your pressure when you're taking a blood pressure reading.
Which is more worrisome systolic or diastolic?Over the years, research has found that both numbers are equally important in monitoring heart health. However, most studies show a greater risk of stroke and heart disease related to higher systolic pressures compared with elevated diastolic pressures.
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What happens when systolic and diastolic are the same
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