It is time to focus on systolic hypertension—especially in older people

Elevation of systolic blood pressure predicts the risk of cardiovascular disease better than increases in diastolic blood pressure.1 Although this was observed more than three decades ago, no attempt was made to translate this evidence into practice until in 1993, when a report of the fifth joint national committee of the United States for the detection, evaluation, and treatment of high blood pressure recognised isolated systolic hypertension as an important target for the control of blood pressure.2 Nevertheless it is the elevation in systolic blood pressure that still limits our ability to control blood pressure to the recommended goal of less than 140/90 mm Hg.3

Although associated with more variability in measurement, systolic blood pressure is easier to determine and allows more appropriate risk stratification than diastolic blood pressure. In a recent analysis of the Framingham heart study, knowing only the systolic blood pressure correctly classified the stage of blood pressure in 99% of adults over age 60 whereas knowing the diastolic blood pressure allowed only 66% to be classified correctly.4 Isolated systolic hypertension is defined as a systolic blood pressure more than or equal to 140 …