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Top Blood Pressure Number Is Key in Seniors

Even When Lower Number Normal, Don't Ignore Top Number, Say Researchers
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WebMD Health News

Aug. 31, 2004 -- People aged 60 and older commonly face a unique blood pressure problem. And new research shows that this is something that shouldn't be ignored.

Blood pressure is noted by two numbers. The upper number, systolic blood pressure, measures the pressure in the arteries when the heart pumps blood throughout the body; the lower number, diastolic blood pressure, is the pressure in the arteries when the heart is relaxing (in between beats).

When systolic blood pressure rises above 160 in people aged 60 and older, it's time to consider treatment -- even if the lower number is normal, less than 90. New research on systolic high blood pressure, which is much more common as we age, is published in The Journal of the American Medical Association.

Sarwat Chaudhry, MD, of the West Haven Veterans Affairs Medical Center in West Haven, Conn., and colleagues conducted the research. Chaudhry's team reviewed more than 1,000 related studies done between 1996 and 2004, focusing on 36 articles in particular.

Chaudhry and colleagues found "strong evidence" to support treating systolic high blood pressure in people aged 60 and older. Doing so can decrease the likelihood of developing heart disease or having a stroke.

Systolic blood pressure is considered high when it's 140 or above. When the lower blood pressure number is less than 90, treatment is generally considered only when systolic blood pressure tops 160. Among older patients, the evidence isn't yet clear that the pros outweigh the cons of treating it in the 140-160 range.

High systolic blood pressure in people 60 and over is a much more important heart disease risk factor than high diastolic blood pressure, write the researchers.

More Studies Needed

More studies are needed to sort that out -- and the sooner, the better. America's population is aging and high systolic blood pressure is becoming all too common, say the researchers.

"Given the scope of the problem and the growing size of the elderly population, there remains an acute need for more study," they write.

Even the most elderly patients -- those older than 85 -- might benefit from treatment, write the researchers. But again, experts can't be sure, since too few of the "oldest old" have been studied so far.

Likewise, it's not yet known how much lifestyle changes such as shaping up, limiting salt and alcohol intake, and getting enough potassium can help older people with high systolic blood pressure. You guessed it -- not enough research there, either.

The two options for treating systolic high blood pressure that had the strongest support in the studies reviewed by Chaudhry's team are thiazide diuretics, commonly known as water pills, and blood pressure medications called long-acting calcium-channel blockers. Doctors have several options to choose from.

Doctors and patients should work together to judge the risks and benefits of systolic high blood pressure treatments, say the researchers. Meanwhile, advanced age doesn't appear to be a reason to automatically avoid treatment.

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