Which is worse in blood pressure systolic or diastolic

By Thor Christensen, American Heart Association News

Systolic blood pressure is the best way to predict future cardiovascular events and death, irrespective of age, according to new research. But in younger people, diastolic blood pressure could still be important.

Systolic pressure – the upper number in a blood pressure reading – measures how hard the heart pumps blood into arteries. Diastolic – the bottom number – indicates the pressure on the arteries when the heart rests between beats.

In recent years, many medical experts shifted their focus to systolic readings when trying to determine the risk of heart problems, but questions lingered about how important diastolic readings really were, said Dr. Michael Hecht Olsen, lead author of a new study published Monday in the American Heart Association journal Hypertension.

To find out more, researchers looked at 26 years of data from 107,599 adults ages 19-97. Participants didn't start out with cardiovascular disease, but some eventually reached a "cardiovascular endpoint," which the study defined as stroke, heart attack or death from heart disease.

The study found that for people under 50, diastolic blood pressure readings "provided additional prognostic predictive information," Olsen said. But the study showed systolic readings were still "a strong predictor of cardiovascular risk independent of age, sex and other cardiovascular risk factors."

"Our results underline the importance of measuring not only the systolic but also the diastolic blood pressure, especially in individuals younger than 50," said Olsen, a hypertension and cardiovascular prevention professor in the department of regional health research at the University of Southern Denmark.

The study also found that mean arterial pressure was a good measure of cardiovascular risk and death at any age. Also called MAP, it is the average pressure in a person's arteries during one cardiac cycle, and it is calculated using both diastolic and systolic blood pressure.

Dr. Deepak L. Bhatt, who was not involved in the research, called it a "well-done study that adds to prior work supporting that diastolic blood pressure is important."

"The implications of this study are that both patients and physicians need to pay attention not only to the systolic blood pressure but also to the diastolic blood pressure," said Bhatt, executive director of Interventional Cardiovascular Services at Brigham and Women's Hospital and professor of medicine at Harvard Medical School in Boston.

"Hypertension remains an extremely common cause of cardiovascular complications such as stroke, heart attack and kidney failure. Further research remains critically important in how best to identify, classify and treat high blood pressure," he said.

According to AHA statistics, nearly half of adults in the United States have high blood pressure, which is defined as systolic blood pressure of 130 mmHg or above or a diastolic blood pressure of 80 mmHg or above. But it's not just an older person's disease. High blood pressure is common among younger adults, affecting more than 1 in 5 people ages 18 to 39, based on data from the Centers for Disease Control and Prevention.

"The study's finding that diastolic blood pressure may be particularly important in younger people is noteworthy," Bhatt said.

High blood pressure often is called a "silent killer" because it quietly damages blood vessels and can lead to serious health problems. While there are medications available to treat the condition, experts say people of all ages can help avoid high blood pressure by eating a well-balanced diet that's low in sodium, limiting alcohol, avoiding tobacco use, engaging in regular physical activity, managing stress and maintaining a healthy weight.

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• Risks
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• Diet
  • What foods help lower blood pressure?
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  • Related Resources - Which Is More Important: Systolic or Diastolic Blood Pressure?

Both systolic and diastolic blood pressure are important in monitoring heart health

When it comes to measuring high blood pressure (hypertension), many wonder whether the number on top (systolic) is more important than the number on the bottom (diastolic).

Typically, systolic blood pressure is given more attention as a risk factor for heart disease. However, both systolic and diastolic blood pressure are equally important in monitoring the health of your heart.

What the numbers measure

• Systolic blood pressure indicates the amount of pressure being exerted on the walls of your arteries when your heart beats.
• Diastolic blood pressure indicates the amount of pressure being exerted on the walls of your arteries in between heartbeats.

Blood pressure ranges

• Normal: Under 120/80 mm Hg
• Elevated: 120-129 systolic, under 80 mm Hg diastolic
• Hypertension Stage I: 130-139 systolic, 80-89 mm Hg diastolic
• Hypertension Stage II: Over 140/90 mm Hg
• Hypertensive crisis: Over 180/120 mmHg. This is a dangerously high reading and requires immediate medical attention.

What are the health risks of high blood pressure?

Recent studies have shown that both high systolic blood pressure and high diastolic blood pressure pose health risks:

• High systolic reading: Increases the risk of heart disease. Systolic blood pressure is linked to heart attacks, heart failure, kidney disease and overall mortality.
• High diastolic reading: Increases the risk of aortic disease. The aorta carries blood and oxygen from the heart to the abdomen and chest. People with an elevated diastolic reading are more prone to developing abdominal aortic aneurysm, an enlargement of the aorta that can lead to rupture and a high risk of death.

What foods help lower blood pressure?

If your blood pressure reads consistently higher than 130/80 when you are in a lying down position, you are considered to have high blood pressure. 

While limiting alcohol consumption and avoiding smoking are the best ways to lower blood pressure, changes to your diet are important as well. Below are examples of foods that can help you bring your blood pressure under control:

• Olive oil: Olive oil is packed with antioxidants and polyphenols that can help lower blood pressure. For maximum health benefits, it’s best to use extra virgin olive oil and eat it as a dressing instead of frying or cooking your food in it.
• Flaxseeds: Studies have shown that flaxseeds are a powerful superfood packed with nutrients. Flaxseeds contain alpha-linolenic acid, an essential omega-3 fatty acid, which helps to lower blood pressure and can also reduce total cholesterol. Flaxseeds can be sprinkled on salads, smoothies or baked goods.
• Low-sodium foods: Limiting salt in the diet is the best way to help kidney function and lower blood pressure. 
• High-potassium foods: Potassium-rich foods also help to lower blood pressure by helping the kidneys flush sodium out of the system. High-potassium foods include spinach,bananas, melons, oranges, apricots, leafy green vegetables, tomatoes, potatoes, sweet potatoes, tuna, salmon, beans, nuts, seeds, Swiss chard and white beans. 
• High-magnesium foods: Magnesium can help relax the blood vessels, making it easier for blood to pass through. Magnesium-rich foods include vegetables, dairy, chicken, legumes and whole grains.

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Medically Reviewed on 5/6/2021

References

Systolic and diastolic hypertension independently associated with CV outcomes: https://pace-cme.org/2019/07/22/systolic-and-diastolic-hypertension-independently-associated-with-cv-outcomes/

Understanding Low Blood Pressure -the Basics: https://www.webmd.com/heart/understanding-low-blood-pressure-basics#