(Hypertension. 2000;35:1021.)
© 2000 American Heart Association, Inc.
Clinical Advisory Statement |
Importance of Systolic Blood Pressure in Older Americans
Key Words: clinical advisory statement • hypertension, detection and control • elderly • blood pressure
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Introduction |
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This clinical advisory statement from the Coordinating Committee of the National High Blood Pressure Education Program is intended to advance and clarify the recommendations of the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI, 1997).1 The advisory addresses several interrelated issues about blood pressure (BP) that affect people approaching the later decades of life. On the basis of the wealth of currently available evidence, the committee now recommends a major paradigm shift in urging that systolic BP become the major criterion for diagnosis, staging, and therapeutic management of hypertension, particularly in middle-aged and older Americans.
Several lines of strong evidence support the initiative to emphasize
systolic BP. Pathophysiologically,
there are strong associations among aging, increased stiffness of large
arteries, increased systolic BP, increased pulse pressure, and
the prevalence of cardiac and vascular disease. Epidemiologically,
isolated systolic hypertension is the most common form of
hypertension and is present in approximately two thirds of
hypertensive individuals >60 years of age. Diagnostically,
classification and staging of hypertension are more precise when
systolic rather than diastolic BP is used as the
principal criterion. Risk stratification for major complications of
hypertension (stroke, myocardial infarction, heart failure, and kidney
failure) is actually confounded by the use of diastolic BP;
in older people with systolic hypertension,
diastolic BP is inversely related to
cardiovascular risk. Clinical benefits of treatment of
isolated systolic hypertension include reductions in stroke,
myocardial infarction, heart failure, kidney failure, and overall
cardiovascular
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