Tradition invariably shackles progress: for almost 100 years the focus of blood pressure measurement has been on diastolic pressure. Now despite persuasive findings from observational studies and the results of trials of interventions to lower systolic pressure, we remain unable to accept the new model in which systolic pressure is pre-eminent. A continuing focus on diastolic pressure throughout adult life is arguably the most important factor contributing to poor control of blood pressure, high residual cardiovascular risk, and global morbidity and mortality.

As recently as 2004, only 5-15% of people in Europe met the guideline targets for blood pressure (<140/90 mm Hg), with the proportion for high risk groups being even smaller.1 The switch in emphasis to the importance of systolic blood pressure is relatively recent, but many doctors who have achieved diastolic control in their patients still fail to modify treatment further to achieve systolic targets.2 …