Perspectives on isolated systolic hypertension in elderly patients

Until the mid-20th century, clinicians' concern was directed mainly to the systolic component of blood pressure.(1) Later, however, when systolic bloo d pressure was found to be elevated with advancing age and decreased compli ance of the arterial wall,(1,2) it began to be considered an inevitable con sequence of aging.(1-3) Based on this belief, physicians often concluded th at only the diastolic blood pressure elevation, which reflected peripheral vascular resistance,(4,5) was harmful, while systolic hypertension was inno cuous.(6) Therapeutic intervention was practiced mainly for diastolic hyper tension, and research protocols were based on the levels of diastolic blood pressure alone.(7-10) In the 1950s, even when life insurance companies' ac tuarial data revealed that systolic and diastolic blood pressure elevations were hazardous to health,(11) few clinicians took heed. In 1962, the World Health Organization also defined hypertension as a blood pressure level of 165/95 mm Hg or higher for intervention purposes.(12) However, until the 1 991 Systolic Hypertension in the Elderly Program (SHEP) trial, many physici ans were reluctant to pay credence to the need for therapy of elevated syst olic blood pressure (vide infra).