What is the most important component of blood pressure: systolic, diastolic or pulse pressure?
OBJECTIVE
Diastolic blood pressure has traditionally been considered the most important component of blood pressure and the primary target of antihypertensive therapy. However, over 30 years ago important epidemiological studies pointed out the importance of systolic blood pressure, and research during the 1990s has strengthened this view. Unlike diastolic blood pressure, systolic blood pressure increases progressively with age, and in the ageing societies elevated systolic pressure is the most common form of hypertension. The characteristic changes of systolic and diastolic blood pressure with age lead to increases in pulse pressure (systolic minus diastolic), which has emerged as a new, potentially independent risk factor. In this review we compare the relative importance of various blood pressure components.


RESULTS
Generally, in studies in which readings of systolic and diastolic blood pressure have been compared, systolic blood pressure has been a better predictor of risk. Moreover, isolated systolic hypertension predicts risk better than isolated diastolic hypertension, and the treatment of both isolated systolic hypertension and combined hypertension has reduced cardiovascular events. There are no treatment studies of isolated diastolic hypertension. Pulse pressure reflects stiffening of large arteries and is associated with several cardiovascular risk factors. Pulse pressure also predicts events in epidemiologic studies, but elucidation of an independent role is hampered by the close correlation between pulse pressure and systolic blood pressure.


CONCLUSIONS
Epidemiological and treatment studies suggest that systolic blood pressure should be the primary target of antihypertensive therapy, although consideration of systolic and diastolic pressure together improves risk prediction. The greatest practical concern at the moment is the undertreatment of hypertension, especially systolic, and total cardiovascular risk.
Strandberg
Timo E
TE
Department of Medicine, Geriatric Clinic, University of Helsinki, Helsinki, Finland. timo.strandberg@hus.fi
Pitkala
Kaisu
K
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D012307:Risk Factors; D013599:Systole / Q000187:drug effects / Q000502:physiology; D014481:United States
D000959:Antihypertensive Agents