UNCERTAINTY exists as to the appropriate goal of antihypertensive therapy
that will provide maximal protection for the majority of patients. In particular,
recently published data show an increase in cardiovascular events in elderly
patients with isolated systolic hypertension whose diastolic levels were inadvertently
lowered to below 65 mm Hg by therapy. Whether such a J-curve exists for those
with combined systolic and diastolic hypertension is less certain.
Whereas the goal of 140/90 mm Hg seems appropriate for relatively low-risk
hypertensive patients, more intensive therapy to reach a goal below 130/80
mm Hg is indicated for those with high-risk hypertension, including those
with diabetes or renal insufficiency. Caution is needed if diastolic levels
go below 65 mm Hg in those with isolated systolic hypertension.
BACKGROUND
With increasing age, systolic blood pressure (BP) continues to rise,
whereas diastolic BP reaches its peak in the fifth decade of life and then
decreases, a reflection . . . [Full Text of this Article]
DIASTOLIC HYPERTENSION: STUDIES SUPPORTING A J-CURVE
DIASTOLIC HYPERTENSION: STUDIES REFUTING A J-CURVE
HYPERTENSION OPTIMAL TREATMENT TRIAL
ISOLATED SYSTOLIC HYPERTENSION
RECOMMENDATIONS
