From the Guidelines
Elevated systolic blood pressure (SBP) is a significant risk factor for cardiovascular disease, including coronary heart disease, heart failure, cerebrovascular disease, and renal failure.
Significance of Elevated SBP
The relationship between SBP and mortality is complex, with evidence suggesting that in patients with established heart failure, higher SBP is associated with better prognosis, whereas in patients with severe left ventricular systolic dysfunction, lower SBP is associated with worse mortality 1.
- In the general population, elevated SBP is a major risk factor for cardiovascular disease, with a doubling of the risk of ischemic heart disease and stroke with every 20 mmHg and 10 mmHg increase in SBP and DBP, respectively, starting from as low as 115 mmHg for SBP and 75 mmHg for DBP 1.
- The Framingham Heart Study showed a greater risk of coronary heart disease in men and women with hypertension (defined as SBP ≥160 mmHg or DBP ≥95 mmHg) than in individuals with SBP <140 mmHg and DBP <90 mmHg 1.
- A wide pulse pressure (SBP minus DBP) has been shown to be a better predictor of adverse cardiovascular outcomes than either SBP or DBP individually, and to identify patients with systolic hypertension who are at particularly high risk 1.
- Individuals with an elevated BP more commonly have other risk factors for CVD (diabetes, insulin resistance, dyslipidaemia) and target organ damage, increasing the overall risk of hypertensive patients 1.
- The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure emphasizes the importance of SBP as a major risk factor for cardiovascular disease 1.
From the Research
Significance of Elevated Systolic Blood Pressure (SBP)
- Elevated SBP is associated with a significantly increased risk of cardiovascular and cerebrovascular morbidity and mortality 2
- The risk of atherosclerotic cardiovascular disease (ASCVD) increases with increasing SBP levels, even at levels considered normal 3
- Studies have shown that lowering SBP in elderly patients with isolated systolic hypertension (ISH) results in a significant reduction in cardiovascular events 2
Risk of Cardiovascular Events
- An SBP of 140 mmHg or higher is associated with a higher risk of incident cardiovascular events compared to an SBP of less than 120 mmHg 4
- A U-shaped association was observed between SBP and diastolic blood pressure (DBP) and the risk of cardiovascular events, with the lowest risk varying by outcome 5
- For every 10-mm Hg increase in SBP, the adjusted hazard ratio for ASCVD was 1.53 (95% CI, 1.17-1.99) 3
Management of Elevated SBP
- First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 6
- The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 6
- First-line drug therapy for hypertension consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 6