Management of hypertension, Part I

Elevated systolic blood pressure increases the risk of a coronary heart disease event to as great or greater a degree as elevated diastolic blood pressure. The fifth Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure has incorporated systolic blood pressure into the new definitions of hypertension. Although the syndrome of white coat hypertension has been well defined, physicians should still rely on casual blood pressure readings taken in the office or clinic for treatment decisions. The levels of blood pressure used to determine risk or estimate prognosis have been based on office or clinic blood pressures. The JNC's suggestion that diuretics or beta blockers be the preferred initial therapy is based on evidence from long-term trials showing that these medications reduce morbidity and mortality not just for cerebrovascular, but also for cardiovascular diseases. The possibly adverse effects of diuretics or beta blockers on lipids and glucose metabolism have probably been overemphasized.