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Perspectives on systolic hypertension. The Framingham study

W B Kannel, T R Dawber, D L McGee

    Circulation
    |June 1, 1980
    PubMed

    Insights

    Systolic hypertension, not just diastolic, significantly increases cardiovascular mortality risk. This is especially true for isolated systolic hypertension, particularly in older adults, highlighting the need for targeted treatments.

    Area of Science:

    • Cardiology
    • Hypertension Research
    • Geriatric Medicine

    Background:

    • Diastolic hypertension is a known cause of cardiovascular mortality.
    • Cardiovascular complications of hypertension were previously thought to stem mainly from the diastolic component.
    • Systolic and diastolic pressures are typically correlated, making it difficult to isolate their individual effects.

    Purpose of the Study:

    • To investigate the independent contribution of systolic blood pressure to cardiovascular mortality.
    • To evaluate the impact of isolated systolic hypertension on cardiovascular outcomes.
    • To determine the association between isolated systolic hypertension and cardiovascular morbidity and mortality, particularly in the elderly.

    Main Methods:

    • Statistical analysis of blood pressure components and cardiovascular outcomes.
    • Examination of risk associated with systolic pressure at low diastolic pressures.
    • Assessment of isolated systolic hypertension in relation to direct complications and atherosclerotic sequelae.
    • Inclusion of pulse-wave recordings to account for arterial stiffness.

    Main Results:

    • Statistical analysis suggests systolic pressure is a more potent contributor to cardiovascular sequelae than diastolic pressure.
    • Isolated systolic hypertension is linked to increased cardiovascular mortality.
    • Even with diastolic pressures below 95 mm Hg, elevated systolic pressure increases risk.
    • Isolated systolic hypertension is particularly detrimental in the elderly and is associated with both direct complications and atherosclerotic sequelae.

    Conclusions:

    • Systolic blood pressure elevation, including isolated systolic hypertension, is a significant independent risk factor for cardiovascular mortality.
    • Isolated systolic hypertension, prevalent in the elderly, requires urgent investigation for effective treatment strategies.
    • Further clinical trials are essential to confirm the efficacy of treating isolated systolic hypertension to reduce cardiovascular morbidity and mortality.

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