A Century of Indirect Blood Pressure Measurement

Hypertension IS one of the most important modifiable risk factors for cardiovascular disease.1Increasing systolic or diastolic blood pressure is directly associated with the development of and death from coronary and cerebrovascular events, heart failure, renal insufficiency, and other manifestations of atherosclerosis.2The risk is graded and continuous across the range of blood pressures within US populations, although, as in the article by Arnett et al3in this issue of theArchives, systolic blood pressure is often a stronger predictor than diastolic blood pressure of cardiovascular disease or events. Reduction of "elevated" systolic or diastolic blood pressure with antihypertensive medications in clinical trials has demonstrated that most of these events are significantly reduced within 5 years.4,5The usual lower levels of entry blood pressure criteria in these trials were 160 mm Hg systolic and 90 to 95 mm Hg diastolic. Subgroup analyses have sometimes but not