Isolated systolic hypertension: a radical rethink
It's a risk factor that needs treatment, especially in the over 50s
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 hyper. tension confers a substantial cardiovascular risk.23 Despite this, it remains underdiagnosed and largely untreated.4 The roots of this lie in a century of over-reliance on the importance of diastolic pressure and largely unjustified concerns about the potential adverse consequences of treating systolic pressure.
After the mercury sphygmomanometer was introduced, convention dictated that diastolic pressure was a better determinant of cardiovascular risk than