Medical memo: Blood pressure and the heart: Lower is better

Medical memo

Blood pressure and the heart: Lower is better

First it happened with cholesterol. When the statin drugs became available around 1990, doctors first concentrated on lowering elevated blood cholesterol levels into the normal range. As they observed important benefits, they began to treat patients who had atherosclerosis despite "normal" cholesterol levels. Again, the drugs produced major reductions in the risk of heart attack and cardiac death.

As studies have continued to accumulate, the goals for LDL ("bad") cholesterol have continued to drop, at least for the patients at the highest risk. Whereas LDL levels of 130 mg/dL are still considered desirable for healthy people, levels below 70 mg/dL are considered optimal for those with acute coronary artery disease (heart attack or unstable angina).

Blood pressure is every bit as important as cholesterol in contributing to heart attack and stroke. As with cholesterol, the higher the reading, the greater the risk. New evidence, in fact, suggests that risk begins to rise with systolic readings above just 115 mm Hg, a level universally considered "normal."

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