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Lower blood pressure is a lot safer - More evidence

(September 2003)

Healthful Life has emphasized that blood pressure is on a continuum - a blood pressure of 110 millimeters of mercury systolic and 65 millimeters of mercury diastolic is safer in regard to heart attack and stroke than a blood pressure of 130 systolic and 80 diastolic which, in turn, is safer than a blood pressure of 145 systolic and 90 diastolic. A recent report in the British journal The Lancet strongly supports our view. The authors analyzed 61 studies about blood pressure and deaths involving a total of one million persons. During the followup period, there were 36,000 deaths from heart disease or stroke. At every age level, a 20 millimeter higher systolic pressure or a 10 millimeter higher diastolic pressure doubled the risk of dying from stroke or heart attack. This was true for both men and women. It could not be determined from the available evidence whether there was any additional health benefit from getting the blood pressure below 115 millimeters systolic, 75 millimeters diastolic.

The importance of these observations is emphasized by the following conclusions: "a 10 millimeter mercury lower usual systolic blood pressure or a 5 millimeter lower usual diastolic blood pressure would be associated with about 40 percent lower risk of stroke death and about 30 percent lower risk of death from heart disease. Even a 2 millimeter mercury lower usual systolic blood pressure would involve about 10 percent lower stroke mortality and about 7 percent lower mortality from heart disease".

Commentary: This is an extremely important study. Blood pressure can be divided into four categories.

A blood pressure even in category 2 increases the risk of stroke and heart attack. Of course, the risk in category 3 is even higher, and still higher in category 4.

It makes sense to be sure your blood pressure is checked at least yearly. If it is above the ideal, you should be trying to get it into the lowest category you can. In category 4, this usually means medications. The following are non-drug approaches to blood pressure control and lowering:

for the evidence that blood pressure effects are on a continuum - the more above the ideal, the greater the risk of blood pressure-related complications, especially stroke and heart attack.

Age-specific relevance of usual blood pressure to vascular mortality. The Lancet. Vol 360 (December 14) Pgs 1903-1913. 2002.

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