Q: I am 65 years old and for some time my systolic blood pressure has remained elevated despite efforts to control my weight and intake of salt. One doctor has told me that medications are not indicated because my diastolic pressure has always been normal. I recently saw another doctor who recommended drug treatment.
A: The blood pressure measurement consists of two numbers -- the higher number is the systolic blood pressure, the lower is the diastolic pressure. The blood pressure is considered elevated if the systolic pressure exceeds 140 and/or the diastolic pressure is greater than 90.
Your problem, an elevation in only your systolic blood pressure (isolated systolic hypertension), increases in frequency with age, especially in those older than 60. While a number of epidemiologic studies have shown that isolated systolic hypertension (ISH) is associated with a greater likelihood of cardiovascular disease and death, until very recently there was no information on whether lowering the blood pressure in people with ISH would reduce these risks.
In June, the Journal of the American Medical Association published a report from the Systolic Hypertension in the Elderly Program (SHEP) on a study carried out at 16 medical centers across the country in 4,736 men and women aged 60 and above. All had ISH. Half of the subjects were placed on medications to lower their blood pressure; the others were on a placebo. Over an average follow-up period of 4.5 years, the group that had their blood pressure lowered by taking medications had a significantly lower incidence of strokes, fatal and nonfatal heart attacks, heart failure, and deaths from all causes. These results of the SHEP strongly suggest that you would benefit from taking antihypertensive medications if your systolic pressure is greater than 160.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.