Is systolic blood pressure all that matters? No

In the recent Head to Head, Eoin O'Brien's comments ('Is systolic
blood pressure all that matters?' BMJ 339:138 No 7713) give more stress to
the need for accurate and repeatable blood pressure measurement than to
the relevance of what an accurate diastolic reading might mean once
ascertained.

Conversely, though Peter Sever's argument to ignore the diastolic BP
makes excellent sense for the worried patient who wants only one peramater
to track, it is perhaps not too much to ask that medical professionals
should be able to interpret diastolic BP in a way that benefits their
appraisal of a patient's cardiovascular risk. As far back as 1999 (SS
Franklin et al Circulation 1999;100:354-360) it was seen that for patients
over 50, the risks associated with raised diastolic blood pressure are not
just small; rather, for a given systolic blood pressure, the higher the
diastolic reading the better.

If this is so, in a patient over 50 whose systolic BP is well
controlled at <140 why could a high diastolic reading not be protective
rather than a small risk factor?

Amongst health professionals therefore, a shift in perception towards
recognising this relationship between diastolic and systolic BP in the
patient population most treated for hypertension may be more valuable than
either ambulatory micro-measurement of blood pressure on the one hand or
wholesale rejection of diastolic measurement on the other.

Competing interests:
None declared