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Is systolic pressure a better target for antihypertensive treatment than diastolic pressure?
G Leonetti1, C Cuspidi, M Facchini
1Istituto Auxologico Italiano and San Luca Hospital, IRCCS, Milan, Italy.
Insights
Systolic blood pressure is a critical risk factor for cardiovascular events, comparable to diastolic blood pressure. Lowering systolic blood pressure through medication significantly reduces cardiovascular risks.
Area of Science:
- Cardiology
- Hypertension Research
- Geriatric Medicine
Background:
- Diastolic blood pressure has been extensively studied for cardiovascular risk.
- Antihypertensive therapy benefits hypertensive patients, reducing cardiovascular event risk.
Purpose of the Study:
- To establish systolic blood pressure as an equally or more important cardiovascular risk factor than diastolic blood pressure.
- To highlight the significance of systolic hypertension in cardiovascular complications.
Main Methods:
- Comprehensive review of existing medical literature.
- Analysis of data from large-scale epidemiological trials and intervention studies.
Main Results:
- Systolic blood pressure is an independent, continuous, and modifiable risk factor for all cardiovascular complications.
- Isolated systolic hypertension is prevalent in the elderly, linked to arterial stiffness and increased pulse pressure.
- Intervention trials show significant cardiovascular benefits from reducing elevated systolic blood pressure in elderly patients.
Conclusions:
- Systolic blood pressure is a crucial, preventable risk factor for cardiovascular events.
- Pharmacological treatment effectively reduces cardiovascular risks associated with elevated systolic blood pressure.
Background:
Diastolic blood pressure has been evaluated in different prospective cohort studies and in pharmacological intervention trials, which have shown the increased risk of cardiovascular events in hypertensive patients and the benefits of antihypertensive therapy.
Aims:
To show that systolic blood pressure is at least as important as, or even more important than, diastolic blood pressure as a risk factor for cardiovascular complications.
Methods:
Review of medical literature.
Results:
Large epidemiological trials such as the Multiple Risk Factors Intervention Trial (MRFIT) and the Framingham study have shown that systolic blood pressure is an independent, continuous and modifiable risk for all cardiovascular complications, and in elderly subjects isolated systolic hypertension is the most frequent form of hypertension. In elderly subjects the increased stiffness of large arteries is responsible for the early reflection of pulse wave and for the decrease in diastolic blood pressure due to reduced recoil of large arteries. This is summarized in the increase in pulse pressure, which is directly related to the risk of cardiovascular complications. Three large intervention trials in elderly patients with isolated systolic hypertension have shown the relevant cardiovascular benefit of pharmacological reduction of elevated systolic blood pressure and normal diastolic values: the cardiovascular benefit is similar to that found in the general hypertensive population and in elderly patients with systolic-diastolic hypertension.
Conclusion:
Systolic blood pressure represents an important risk factor for cardiovascular events which can be prevented or reduced with pharmacological treatment.