Historic perspectives on the relative contributions of diastolic and systolic blood pressure elevation to cardiovascular risk profile

The aim of this review was to examine the relative contributions of systoli c and diastolic blood pressures to the risk of cardio vascular disease on t he basis of epidemiologic evidence From the Framingham Heart Study and the change in attitudes toward systolic blood pressure that occurred during the course of the study. Historic texts were evaluated in comparison with data from the Framingham Heart Study, a prospective longitudinal analysis of th e relation between blood pressure and occurrence of subsequent cardiovascul ar morbidity and mortality rates in a fixed cohort. Historically, systolic hypertension has been considered an innocent accompaniment to arterial stif fening, occurring as a compensatory phenomenon in the elderly. Epidemiologi c data show that the development of hypertension is neither inevitable nor beneficial. The data also provide evidence that systolic pressure is more i mportant than diastolic pressure as a determinant of cardiovascular sequela e. Mild or moderate elevations of systolic blood pressure, even when unacco mpanied by diastolic pressure elevations, ore associated with an increased risk of cardiovascular disease. Risk is increased further by the added pres ence of related metabolic disturbances such as dyslipidemia, glucose intole rance, insulin resistance, cardiac hypertrophy, and obesity. Overreliance o n diastolic blood pressure in assessing the risk of hypertension can be mis leading. Systolic pressure constitutes a powerful predictor of cardiovascul ar disease and a valuable tool when incorporated within multivariate risk f ormulas for estimating the conditional probability of coronary and stroke e vents.