Systolic Pressure Best Indicator Of Heart Disease In Hypertensive Men

Systolic blood pressure (SBP) is a good indicator of cardiovascular disease and coronary heart disease in hypertensive men being treated in clinical practice.

Diastolic blood pressure (DBP), on the other hand, appears to have little value in determining cardiovascular risk in this group of patients, say French and American researchers. They note diastolic pressure is still the main criterion most doctors use to determine drug efficacy among hypertensive men.

“Evaluation of risk in treated individuals should take SBP rather than DBP values into account,” state investigators from the Centre d’Investigations Préventives et Cliniques and the Institut de la Santé et de la Recherché Médicale in Paris and the State University of New York in New York City.

They report that the most important result of their study of 4,714 hypertensive men is that cardiovascular mortality – especially coronary heart disease mortality – is much higher in uncontrolled hypertensive men than in controlled hypertensive men and that SBP levels, not DBP levels, predict risk independent of age.

Participants were all treated by physicians and had a standard health check-up at the Centre d’Investigations Préventives et Cliniques from 1972 to 1988. Researchers tracked cardiovascular and coronary heart disease mortality in participants for a mean of 14 years.

A total of 85.5 percent of participants being treated for hypertension presented uncontrolled SBP values and/or DBP values. Their risk ratio for increased cardiovascular mortality, after adjustments for age and associated risk factors, was 1.66 compared with patients with controlled hypertension. Their risk ratio for increased coronary heart disease mortality was 2.35.

“After adjustment for age, associated risk factors, and DBP, and compared with subjects with SBP under 140 mmHg, the risk ratio for cardiovascular disease mortality was 1.81 in subjects with SBP between 140 and 160 mmHg and 1.94 in subjects with SBP over 160 mmHg,” investigators say. “By contrast, after adjustment for SBP levels, cardiovascular disease risk was not associated with DBP.”

The researchers point out that the lack of predictive value for DBP could result because patients with high DBP levels are more likely to receive more aggressive treatment than patients with high SBP levels. But, they add that it cannot be assumed that patients with high DBP levels are subsequently normalised. Recent research indicates that high DBP values are not normalised in a majority of hypertensive patients under care.

Archives of Internal Medicine, 2002; 162: 577-581. “Prognostic Value of Systolic and Diastolic Blood Pressure in Treated Hypertensive Men”