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.). High Blood Pressure/HypertensionNot what you're looking for? What is high blood pressure?Blood pressure is the force of the blood pushing against the artery walls. The force is made with each heartbeat as blood is pumped from the heart into the blood vessels. This is called systolic blood pressure. Blood pressure is also affected by the size of the artery walls and their elasticity. Each time the heart beats (contracts and relaxes), pressure is created inside the arteries. When the heart is relaxed, the arteries stay at a lower resting tone to maintain some pressure in the artery. This is called diastolic blood pressure. High blood pressure is when the force of the blood is too high during heart contraction or relaxation within the arteries. The arteries may have an increased resistance against the flow of blood. This causes your heart to pump harder to circulate the blood. What causes high blood pressure?These factors may cause high blood pressure:
Who is at risk for high blood pressure?More than half of all adult Americans have high blood pressure. You are at risk for it if you:
What are the symptoms of high blood pressure?High blood pressure often has no symptoms. But you can find out if your blood pressure is higher than normal by checking it yourself or by having it checked regularly by your healthcare provider. Very high blood pressure can cause symptoms. These include headache, changes in vision, or chest pain. How is high blood pressure diagnosed?Blood pressure is measured with a blood pressure cuff and stethoscope by a nurse or other healthcare provider. You can also take your own blood pressure with an electronic blood pressure monitor. You can find one at most pharmacies.
Two numbers are recorded when measuring blood pressure:
Both the systolic and diastolic pressures are recorded as mm Hg (millimeters of mercury). This recording represents how high the mercury column in the blood pressure cuff is raised by the pressure of the blood. Blood pressure is rated as normal, elevated, or stage 1 or stage 2 high blood pressure:
Even higher blood pressure (with the systolic blood pressure 180 or higher, the diastolic blood pressure more than 120, or both) is called a hypertensive urgency if there are no related symptoms. Or it's called a hypertensive emergency if there are symptoms indicating damage to the brain, heart, or kidneys. If you have a hypertensive urgency, you may need a change in your medicine right away or be evaluated in an emergency room. If you have a hypertensive emergency, you will need to be evaluated in an emergency room; and likely have a stay in the hospital. A single higher blood pressure measurement does not always mean you have a problem. Your healthcare provider will want to see several blood pressure measurements over a number of days or weeks before diagnosing high blood pressure and starting treatment. Ask your provider when you should call if your blood pressure readings are not in the normal range. How is high blood pressure treated?Treatment for high blood pressure may involve: Lifestyle changesThese healthy steps can help you control your blood pressure:
Certain medicinesSometimes you may need to take 1 or more daily medicines to control high blood pressure. Take it exactly as directed. If you have high blood pressure, have your blood pressure checked routinely and see your healthcare provider to watch the condition. What are possible complications of high blood pressure?High blood pressure raises your risk for:
How do I prevent high blood pressure?You can help prevent high blood pressure with many of the same healthy steps used to treat it. These are:
Key points about high blood pressure
Next stepsTips to help you get the most from a visit to your healthcare provider:
Medical Reviewer: Steven Kang MD Medical Reviewer: Ronald Karlin MD Medical Reviewer: Stacey Wojcik MBA BSN RN © 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. Not what you're looking for? Can diastolic number be higher than systolic?It reflects the amount of pressure inside the arteries as the heart contracts. The bottom (second) number, diastolic pressure, is always lower since it reflects the pressure inside the arteries during the resting phase between heartbeats. As it turns out, both systolic and diastolic blood pressure are important.
What if my diastolic is high but systolic is normal?However, isolated diastolic hypertension (IDH) occurs when your systolic blood pressure is normal, and only your diastolic blood pressure is high (over 80 mm Hg). IDH is an uncommon type of hypertension, accounting for less than 20% of all hypertension cases.
What is a dangerously high diastolic number?A high diastolic reading (equal to or greater than 120 mmHg) is associated with an increased risk of stroke, heart attack, and other cardiovascular problems.
Why is only my diastolic high?Common causes of isolated diastolic hypertension are: endocrine disorders. renovascular disorders. sleep apnea.
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