Elevated systolic blood pressure as a cardiovascular risk factor

This paper reviews the evolution of attitudes toward the treatment and diag nosis of hypertension. In particular, there is a growing realization that e levated systolic pressure may be a more valuable measurement in evaluating and controlling hypertension than is generally acknowledged. A large number of epidemiologic studies in a wide variety of populations have revealed th at systolic blood pressure exerts a stronger influence than diastolic blood pressure, The largest of these, the Framingham Heart Study, showed that in subjects with systolic hypertension, diastolic blood pressure was only wea kly related to the risk of cardiovascular events, but in those with diastol ic hypertension, the risk of these events was strongly influenced by the le vel of systolic pressure. Furthermore, cardiovascular event rates were foun d to increase steeply with systolic pressure and were higher in cases of is olated systolic hypertension than diastolic hypertension, Clinical trials p roduced similar results, again suggesting that a greater reliance should be placed on systolic pressure in evaluating the risk of cardiovascular probl ems. This review concludes that the health community needs to be reeducated to consider the importance of systolic and diastolic blood pressure in ass essing appropriate management strategies for hypertensive patients. (C) 200 0 by Excerpta Medica, Inc.