Medical questions answered by a Doctor

I have shared these posts from Doctor L Komaraff editor in chief from Harvard Health letter for people that may need certain health questions answered.

Ask the doctor: Treatment for high systolic pressure?

Anthony L. Komaroff, M.D.

Q. I’m 71 and my systolic pressure is usually in the 150s to 160s, which is high, but my diastolic is usually in the 80s, which is normal. Do I need treatment?

A. A blood pressure measurement includes two numbers: systolic pressure (the upper number) and diastolic pressure (the lower number). Your systolic pressure is high: 140 or over is high. And your lower number is not normal: normal diastolic pressure is below 80. However, even if your diastolic pressure were truly normal, say 70, you would still benefit from treatment. You would have a condition called isolated systolic hypertension (ISH). Many studies have shown that treatment of people with ISH lowers their risk of heart disease and stroke.

If you are not currently being treated for high blood pressure (hypertension), your doctor might start with lifestyle changes. Regular exercise, weight loss, and cutting down on salty foods and added salt in your diet might fix the problem without medications. If medications are tried, because of your age, your doctor will probably aim first to gently lower your systolic pressure to below 150. If you don’t have any bothersome symptoms, such as lightheadedness, your doctor will then probably push to get your systolic pressure below 140. Such treatment is also likely to lower your diastolic pressure, but the focus should be on your systolic pressure.

I was taught three things in medical school: (1) all that really mattered was the diastolic pressure, (2) older people had naturally higher pressures that didn’t necessarily need treatment, and (3) when you treated older patients, it caused symptoms such as lightheadedness. Research since I was a medical student has shown conclusively that (1) and (2) are wrong. In fact, they were backward: systolic matters more than diastolic pressure, and older people clearly benefit from treatment. It is true that a minority of older patients do develop symptoms if blood pressure is lowered too suddenly, which is why your doctor is likely to go slow.

—Anthony L. Komaroff, M.D.
Editor in Chief
Harvard Health Letter