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If you’ve been told you only have to worry about getting the top number of your blood pressure down, you may want to get a second opinion.

That’s what researchers in a new study are saying.

“The take home message here is that when you’re getting your blood pressure checked, we need to pay attention to both numbers, the systolic and the diastolic,” Dr. Alexander Flint, a stroke specialist at Kaiser Permanente in Northern California and lead author of the study, told Healthline.

The top number, or systolic, reflects how hard your heart is working to pump blood into your arteries. The bottom number, or diastolic, indicates the pressure as your heart relaxes between beats.

Researchers concluded that both numbers were independent predictors of heart attacks and strokes.

“Both the top and the bottom number are strongly linked to outcomes of ischemic stroke, the type of stroke where a blood clot blocks an artery in the brain, as well as hemorrhagic stroke, bleeding in the substance of the brain, and heart attacks,” Flint said.

“This study goes against previous data which shows systolic blood pressure is generally more important,” Ramin Oskoui, a Washington, D.C., cardiologist, told Healthline.

Oskoui is also chief executive officer of Foxhall Cardiology and is affiliated with Sibley Memorial Hospital, Suburban Hospital, and Washington Hospital Center.

In fact, Flint says the findings turn upside down decades of commonly held beliefs about blood pressure readings.

“There had been quite a lot of discussion in the medical literature about this idea that systolic blood pressure was so much more important than diastolic blood pressure, based on previous studies. That perhaps we don’t have to pay attention to diastolic blood pressure. And if that were true, it might present an opportunity to simplify therapy. Let’s only talk about the one number,” Flint explained.

“Here the data are telling us that if we were to ignore the diastolic blood pressure, that would be to the detriment of our patient’s care,” he added.

What researchers learned

This study is being called the largest of its kind.

Between 2007 and 2016, the research team analyzed 36 million outpatient blood pressure readings from more than 1 million adult members of Kaiser Permanente in Northern California.

They concluded that while systolic blood pressure had a greater impact, both systolic and diastolic pressures influenced your risk factors.

That was true whether measured against the older threshold of 140/90 or the newer guidelineof 130/80.

How does it change treatment?

Flint said the findings won’t change much when it comes to treating your blood pressure with medications.

“It turns out that the medications do both, so we don’t have to make things more complicated in terms of picking and choosing medications,” Flint said.

“Everybody reacts to the medications in different ways. Really, it’s just a matter of working with your physician to find the right medication, the right dose to achieve both of those numbers. All the classes of anti-hypertensive medications work for both numbers,” he said.

“While these findings may not make much difference in the medications I give my patients, it is an opportunity to reinforce with the lay public that the lower your blood pressure, the lower your risk of heart attack, heart failure, stroke, and kidney disease,” Oskoui said.

“We can remind our patients to cut out alcohol, exercise in moderation, and lose weight. Even a 10 to 15 pound weight loss can mean the difference between medication or not,” Oskoui added.

That advice echoes what the American Heart Association recommends:

• Eat a well-balanced diet low in salt.
• Limit your alcohol.
• Get regular physical activity.
• Manage your stress.
• Maintain a healthy weight.
• Quit smoking.
• Take your medications as prescribed.
• Work with your doctor.

Next steps in the research?

“We can look at mortality, we can look at different predictors related to blood pressure, specifically the ‘pulse pressure,’ which is a mathematical subtraction of the systolic and diastolic numbers,” Flint said. “In certain circumstances, it may be an independent predictor that is important, so we’re exploring that.”

Flint says this study was carried out using a big data approach with information from the Kaiser healthcare system.

“We have many, many clinics and all those clinics are putting data into electronic medical records, so we are really able to do analytics like this at a close to population-level,” Flint said.

In the not-too-distant future, he said, researchers may be gathering blood pressure data from noninvasive wearable sensors.

“This is sort of a stepping stone toward that even bigger data approach to learning more about the relationship between blood pressure and other factors and the risk of cardiovascular events. We could hopefully identify people at much finer level who are at risk and tailor medical therapy for them,” Flint added.FEEDBACK:

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(Reuters Health) – People with high blood pressure or elevated cholesterol before age 40 are more likely to have a heart attack later in life than other adults, a new analysis suggests.

The analysis pooled data from six studies involving a total of 36,030 people. Starting when participants were 53 years old on average, researchers tracked them to see who had heart attacks, strokes, or heart failure.

By the time half of the people had been tracked for at least 17 years, participants who had high levels of “bad” LDL cholesterol before age 40 – that is, higher than about 129 milligrams per deciliter of blood – were 64% more likely to have had events like heart attacks compared to people with low LDL levels in early adulthood.

The upper limit of normal blood pressure is 120/80. Younger adults who had high systolic blood pressure – the “top number” – were 37% more likely to develop heart failure later in life. And young adults who had elevated diastolic blood pressure – the “bottom number” – were 21% more likely to develop heart failure later on.

“Many young adults feel OK, or they’re willing to think–I’m OK now, I will make healthful choices later when I’m older,” said Dr. Andrew Moran, senior author of the study and a researcher at Columbia University Medical Center in New York City.

“This study shows that healthy choices matter even in young adults,” Moran said by email. “This means not smoking, eating a healthful diet, and exercising regularly.”

And for some high risk young adults, starting medication to manage risk factors at a younger age – something that currently isn’t done as a matter of course – may be worthwhile, Moran added.

Very few people in the study had high blood pressure or high cholesterol during young adulthood, researchers report in the Journal of the American College of Cardiology.

During follow-up, 4,570 participants had events like heart attacks, 5,119 had heart failure events, and 2,862 had strokes.

The study can’t explain whether or how high blood pressure or elevated cholesterol in early adulthood might directly cause heart attacks, strokes or heart failure later in life.

One limitation of the analysis is that because the smaller studies used in the analysis didn’t have blood pressure and cholesterol measurements across the lifespan, in some cases researchers had to estimate how many younger adults had these risk factors based on the data they had for participants at older ages.

“Heart failure and heart attacks are the result of years of exposure to risk factors like high blood pressure and cholesterol,” said Dr. Samuel Gidding, coauthor of an editorial accompanying the study and medical director of the FH (Familial Hypercholesterolemia) Foundation in Pasadena, California.

“Both cause the buildup of fat in the coronary arteries beginning in childhood; this leads to heart attack later in life,” Gidding said by email. “High blood pressure puts extra strain on the heart and adapting to that stress leads to heart failure.”

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Getting eight hours sleep may be critical for your blood pressure — and your heart.

A bad night’s sleep can result in a spike in blood pressure that night and the following day, according to the results of new research released Wednesday. The study, published in the latest edition of the peer-reviewed scientific journal Psychosomatic Medicine and led by scientists at the University of Arizona, offers one possible explanation for why sleep problems have been shown to increase the risk of heart attack, stroke and even death from cardiovascular disease.

Some 300 men and women, ages 21 to 70, with no history of heart problems were given portable blood pressure cuffs for two consecutive days. The cuffs randomly took participants’ blood pressure during 45-minute intervals throughout each day and also overnight. They also wore “actigraphy monitors” on their wrists that measured movement to help determine their “sleep efficiency.”

‘Blood pressure is one of the best predictors of cardiovascular health.’
—Caroline Doyle, a graduate student at the University of Arizona’s Department of Psychology
Those participants who had lower “sleep efficiency” showed an increase in blood pressure during that restless night. They also had higher systolic blood pressure — the number in a person’s blood pressure reading — the next day. The researchers said getting a good night’s sleep is important for good long-term health, but so is getting quality sleep, and recommended keeping your smartphone in another room, and pulling down the shades if your bedroom faces east.

“Blood pressure is one of the best predictors of cardiovascular health,” said lead study author Caroline Doyle, a graduate student at the University of Arizona’s Department of Psychology. “There is a lot of literature out there that shows sleep has some kind of impact on mortality and on cardiovascular disease, which is the No. 1 killer of people in the country. We wanted to see if we could try to get a piece of that story – how sleep might be impacting disease through blood pressure.”

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Short sleepers had a 48% increased risk of developing or dying from coronary heart disease and a 15% greater risk of developing or dying from stroke, according to a 2011 study published in the European Heart Journal analyzed the sleep patterns of almost 475,000 people over 25 years.

Scientists have also said a lack of sleep over a prolonged period of time can lead to calcification of arteries, hypertension (higher blood pressure), the release “C-reactive protein,” which is connected with stress and inflammation, and reduce insulin, which regulates blood sugar levels.

Scientists say a prolonged lack of sleep can lead to calcification of arteries.
“Patients with sleep apnea often have compromised heart health,” according to the National Sleep Foundation. “This is because without long, deep periods of rest, certain chemicals are activated that keep the body from achieving extended periods in which heart rate and blood pressure are lowered.” This 2008 study in the Journal of Clinical Sleep Medicine concluded that individuals with severe sleep apnea are at increased risk for coronary artery disease, congestive heart failure, and stroke.

There are other ways to reduce hypertension. A diet that helps people reduce high blood pressure or hypertension may also reduce the risk of heart failure in people under the age of 75, according to separate research recently published in the latest edition of the American Journal of Preventive Medicine, and led by doctors at Wake Forest School of Medicine, which is part of Wake Forest Baptist Health in Winston-Salem, N.C.

An observational study of more than 4,500 people over 13 years showed that those individuals under 75 who most closely adhered to the Dash diet had a significantly lower risk of developing heart failure than those who were least likely to keep to the tenets of the diet. (Dash is an acronym for Dietary Approaches to Stop Hypertension.)

The study recommends cutting five things out of your diet: This Dash diet recommends eating fruits, vegetables, nuts, whole grains, poultry, fish and low-fat dairy products, while reducing consumption of three main components: salt, red meat, sweets and sugar-sweetened beverages. It is very similar to the Mediterranean diet, but the Dash diet recommends cutting out two more things: full cream (in favor of low-fat dairy products) and alcoholic beverages.

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