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Isolated systolic hypertension: a radical rethink

BMJ 2000; 320 doi: (Published 24 June 2000) Cite this as: BMJ 2000;320:1685

This article has a correction. Please see:

It's a risk factor that needs treatment, especially in the over 50s

  1. Ian B Wilkinson, lecturer in clinical pharmacology,
  2. David J Webb Christison, professor,
  3. John R Cockcroft, senior lecturer in cardiology (
  1. Clinical Pharmacology Unit, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU
  2. Department of Cardiology, University Wales College of Medicine, Heath Park, Cardiff CF4 4XN

    The association between hypertension and a “hardening” of the pulse and apoplexy has been recognised for hundreds of years. The major problem in elderly people is isolated systolic hypertension, defined as a raised systolic pressure but normal diastolic pressure. It affects around half of people aged over 60 years.1 Originally, because isolated systolic hypertension was so common it was considered part of ageing and, like essential hypertension, benign. However, there is now compelling evidence from cross sectional, longitudinal, and randomised controlled trials that show that isolated systolic hypertension confers a substantial cardiovascularrisk.2 3 Despite this, it remains underdiagnosed and largely untreated.4 The roots of this lie in a century of overreliance on the importance of diastolic pressure and largely unjustified concerns about the potential adverse consequences of treating systolic pressure.

    After the mercury sphygmomanometer …

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