Dear Dr. SerVaas: In the March/April 2001 "Medical Mailbox" it was stated that a wide range between the top and bottom blood pressure readings raises stroke risk. I have had a wide range in my readings for years--often 80 points apart. I am 78 years old, and the only reason I have gone to a doctor in the last five years is for yearly GYN checkups. I recently checked my pressure at the drugstore and it was 146/70. If I took blood pressure medicine, would that make my diastolic go even lower?

Dorothy Pledger
Mountain City, Tennessee

Dear Reader: We sent your letter to Dr. Myron Weinberger, professor of medicine at the Indiana University School of Medicine and director of the Hypertension Research Center. Dr. Weinberger responds:

"Fortunately, the systolic (upper) pressure generally responds to treatment much more than the diastolic (lower) pressure, particularly in those with the major increase in systolic pressure. Thus, with the proper medication, it should be possible to lower the systolic pressure without excessive reduction in the diastolic pressure.

"In 1997, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure indicated that the goal blood pressure for all individuals should be less than 140/90. In older individuals there is often a disproportionate increase in the systolic blood pressure number, resulting in a wide difference between the two readings. As you mention, an increased pulse pressure has been shown to be the strongest predictor of every cardiovascular event in comparison to systolic or diastolic pressure alone."