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(Hypertension. 1999;34:386-387.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
The Paradigm Has Shifted, to Systolic Blood Pressure
From the Department of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill.
Correspondence to Henry R. Black, MD, Charles J. and Margaret Roberts Professor and Chairman, Department of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, 1700 W Van Buren St, Room 400, Chicago, IL 60612. E-mail hblack@rush.edu
Key Words: Editorials • blood pressure, systolic • risk factors
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Introduction |
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In this issue of Hypertension,1 Lloyd-Jones and colleagues from the Framingham Heart Study report on the results of their categorization of blood pressure stage by both systolic and diastolic blood pressure in 3656 subjects from both the original cohort and the Framingham Offspring cohort. They showed that systolic blood pressure was far more likely to correctly classify individuals as having hypertension, or a high-normal or normal blood pressure, than was diastolic blood pressure. Their data confirmed the value of using both systolic and diastolic blood pressure to determine blood pressure classification, a practice only recently suggested by expert committees.2 Now both the Sixth Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) in 1997 and the more recent World Health Organization/International Society of Hypertension (WHO/ISH) guidelines subcommittee agreed that both values should be used for classification and that the higher stage (in JNC VI) or grade (in WHO/ISH) should be considered to be the subgroup in which the subject belonged.3 4
The importance of these staging systems and the resultant
classification of our patients has never been and is especially not now
a trivial issue. Both expert committees have recommended basing
treatment recommendations for when to start therapy, especially when to
start pharmacological treatment, on the blood pressure stage (or grade)
and on the presence or absence of risk factors and target-organ damage.
The level of blood pressure, which represents increasing
relative risk as it rises, and the level of associated conditions or
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