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(Hypertension. 1999;34:381-385.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
Differential Impact of Systolic and Diastolic Blood Pressure Level on JNC-VI Staging
From the National Heart, Lung, and Blood Institute's Framingham Heart Study, National Institutes of Health (D.M.L.-J., J.C.E., M.G.L., C.J.O., D.L.); the Cardiology Division, Department of Medicine, Massachusetts General Hospital (D.M.L.-J., C.J.O.), Harvard Medical School; the Division of Epidemiology and Preventive Medicine, Boston University School of Medicine (J.C.E., M.G.L., D.L.); and the Department of Medicine, Beth Israel-Deaconess Medical Center (D.L.), Harvard Medical School, Boston, Mass.
Correspondence to Daniel Levy, MD, Framingham Heart Study, 5 Thurber St, Framingham, MA 01702. E-mail dan{at}fram.nhlbi.nih.gov
Abstract—The sixth Report
of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure classifies blood pressure into
stages on the basis of both systolic (SBP) and
diastolic (DBP) blood pressure levels. When a disparity
exists between SBP and DBP stages, patients are classified into the
higher stage ("up-staged"). We evaluated the effect of disparate
levels of SBP and DBP on blood pressure staging and eligibility for
therapy. We examined 4962 Framingham Heart Study subjects between 1990
and 1995 and determined blood pressure stages on the basis of SBP
alone, DBP alone, or both. After the exclusion of subjects on
antihypertensive therapy (n=1306), 3656 subjects (mean age 58±13
years; 55% women) were eligible. In this sample, 64.6% of subjects
had congruent stages of SBP and DBP, 31.6% were up-staged on the basis
of SBP, and 3.8% on the basis of DBP; thus, SBP alone correctly
classified JNC-VI stage in 
96% (64.6%+31.6%) of the subjects.
Among subjects >60 years of age, SBP alone correctly classified 99%
of subjects; in those 
60 years old, SBP alone correctly classified
95%. Of 1488 subjects with high-normal blood pressure or hypertension,
who were potentially eligible for drug therapy, 13.0% had congruent
elevations of SBP and DBP, 77.7% were up-staged on the basis of SBP,
and 9.3% were up-staged on the basis of DBP; SBP alone correctly
classified 91%, whereas DBP alone correctly classified only 22%. SBP
elevation out of proportion to DBP is common in middle-aged and older
persons. SBP appears to play a greater role in the determination of
JNC-VI blood pressure stage and eligibility for therapy. Given these
results, combined with evidence from hypertension treatment trials,
future guidelines might consider a greater role for SBP than for DBP in
determining the presence of hypertension, risk of
cardiovascular events, eligibility for therapy, and
benefits of treatment.
Key Words: hypertension, detection and control • risk factors • epidemiology • guidelines
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