From the Guidelines
Systolic blood pressure is ≥140 mmHg and diastolic blood pressure is ≥90 mmHg in individuals with hypertension, according to the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
Key Points
- Systolic pressure measures the force the heart exerts on artery walls when it beats, while diastolic pressure measures the force when the heart rests between beats.
- A normal blood pressure reading is typically around 120/80 mmHg, with the first number representing systolic and the second representing diastolic.
- Elevated systolic pressure (above 140) and elevated diastolic pressure (above 90) can indicate hypertension, which increases the risk for heart disease, stroke, and kidney problems, as stated in the 2024 ESC guidelines 1.
Blood Pressure Classification
- Systolic BP 120–139 or diastolic BP 70–89 mmHg is classified as elevated BP, as per the 2024 ESC guidelines 1.
- Hypertension is defined as a systolic BP ≥140 or diastolic BP ≥90 mmHg, which requires long-term management to reduce the risk of serious acute cardiovascular disease events, such as stroke or heart attack 1.
Importance of Blood Pressure Monitoring
- Regular blood pressure monitoring is crucial to assess cardiovascular health and the effectiveness of medications and behavioral changes in managing hypertension, as emphasized in the 2024 ESC guidelines 1.
- Accurate blood pressure readings can be obtained by measuring blood pressure while seated quietly with the arm supported at heart level, after resting for 5 minutes, and without having consumed caffeine or exercised in the previous 30 minutes.
From the FDA Drug Label
Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit
Systolic and Diastolic refer to the two types of blood pressure measurements.
- Systolic pressure is the top number, which represents the pressure in the blood vessels when the heart beats.
- Diastolic pressure is the bottom number, which represents the pressure in the blood vessels when the heart rests between beats. The FDA drug labels provided do not give a detailed definition of systolic and diastolic pressure, but they do mention that elevated systolic or diastolic pressure causes increased cardiovascular risk 2, 3.
From the Research
Definition of Systolic and Diastolic Blood Pressure
- Systolic blood pressure (SBP) is the pressure in the arteries when the heart beats and pumps blood into the circulation 4.
- Diastolic blood pressure (DBP) is the pressure in the arteries when the heart rests between beats 4.
Measurement and Comparison of Systolic and Diastolic Blood Pressure
- The auscultatory method is considered the gold standard for measuring blood pressure, but a newer palpatory method has been shown to have excellent reliability with an intraclass correlation (ICC) value of 0.997 and 0.993 for SBP and DBP, respectively 5.
- Studies have compared the effects of systolic and diastolic hypertension on cardiovascular outcomes, with both independently predicting adverse outcomes 6.
Effects of Systolic and Diastolic Hypertension on Cardiovascular Outcomes
- Systolic hypertension has been recognized as an independent risk factor that far exceeds the risk associated with an elevated diastolic blood pressure in older patients with hypertension 7.
- Diastolic hypertension also independently influences the risk of adverse cardiovascular events, regardless of the definition of hypertension (≥140/90 mm Hg or ≥130/80 mm Hg) 6.
- Pulse pressure, the difference between systolic and diastolic pressure, has been shown to be an independent factor of cardiovascular risk 7, 8.
Clinical Significance of Systolic and Diastolic Blood Pressure
- Hypertension, defined as persistent systolic blood pressure at least 130 mm Hg or diastolic blood pressure at least 80 mm Hg, affects approximately 116 million adults in the US and more than 1 billion adults worldwide 4.
- First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption, with first-line drug therapy consisting of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 4.