Systolic Hypertension as a Cardiovascular Risk Factor

A CARDIOVASCULAR PARADIGM SHIFT For many years convention held that diastolic blood pressure (DBP) was more important than systolic blood pressure (SBP) in blood pressure (BP) management.Increases in SBP were thought to be a normal part of the aging process leading to the concept, still current in the minds of many practitioners, that "100-plus-your-age " is a reasonable SBP level.Elevated SBP was largely ignored.A high SBP was even thought to be bene cial showing the health and strength of the left ventricle.In those with isolated stolic hypertension, the opinion was that antihypertensive therapy would not improve outcome and might be harmful.Recent years have seen a paradigm shift in the management of hypertension.Systolic hypertension is now recognized to have an importance as least as great as that attributable to raised DBP.This article considers the reasons for this change in policy and describes a logical therapeutic approach.