Current Cardiology Reports

, Volume 4, Issue 6, pp 463–467 | Cite as

Systolic versus diastolic blood pressure versus pulse pressure

  • William B. White


Elevation of systolic blood pressure (BP) has been recognized as an independent risk factor that far exceeds the risk associated with an elevated diastolic BP in older patients with hypertension. Isolated systolic hypertension (ISH) is a disorder typically defined when the systolic BP is greater than 140 mm Hg but with diastolic BP below 90 mm Hg. Pulse pressure (the difference between systolic and diastolic pressure) has recently become an active area of discussion in the literature as an independent factor of cardiovascular risk. An increased pulse pressure nearly always indicates reduced vascular compliance of large arteries and, by definition, is always increased in patients with isolated systolic hypertension. Although the evidence that a widened pulse pressure is an independent marker of cardiovascular risk is quite well established, therapeutic morbidity and mortality studies in ISH have focused on reductions in systolic pressure. At the present time, outcomes data have not been well established for reductions in pulse pressure in older patients with hypertension.


Pulse Pressure Systolic Hypertension Eplerenone Fosinopril Isolate Systolic Hypertension 
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References and Recommended Reading

  1. 1.
    Stamler J, Stamler R, Neaton J: Blood Pressure, systolic and diastolic, and cardiovascular risks: US population data. Arch Intern Med 1993, 153:598–615.PubMedCrossRefGoogle Scholar
  2. 2.
    The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The 6th report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997, 157:2413–2446.Google Scholar
  3. 3.
    SHEP Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991, 265:3255–3264.CrossRefGoogle Scholar
  4. 4.
    Staessen JA, Fagard R, Thijs L, et al., for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997, 350:757–764.PubMedCrossRefGoogle Scholar
  5. 5.
    Vardan S, Mookherjee S: Perspective on isolated systolic hypertension in elderly patients. Arch Fam Med 2000, 9:319–323.PubMedCrossRefGoogle Scholar
  6. 6.
    White WB: Benefits of antihypertensive therapy in older patients with hypertension. Arch Intern Med 2000, 160:149–150.PubMedCrossRefGoogle Scholar
  7. 7.
    Smulyan H, Safar ME: The diastolic blood pressure in systolic hypertension. Ann Intern Med 2000, 32:233–237.Google Scholar
  8. 8.
    Domanski MJ, Davis BR, Pfeffer MA, et al.: Isolated systolic hypertension: Prognostic information provided by pulse pressure. Hypertension 1999, 34:375–380.PubMedGoogle Scholar
  9. 9.
    Franklin SS, Sutton-Tyrell K, Belle SH, et al.: The importance of pulsatile components of hypertension in predicting carotid stenosis in older adults. J Hypertens 1997, 15:1143–1150.PubMedCrossRefGoogle Scholar
  10. 10.
    Vaccarino V, Holford TR, Krumholz HM: Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol 2000, 36:130–136.PubMedCrossRefGoogle Scholar
  11. 11.
    Benetos A, Safar M, Rudnichi A, et al.: Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population. Hypertension 1997, 30:1410–1415.PubMedGoogle Scholar
  12. 12.
    Blacher J, Staessen JA, Girerd X, et al.: Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000, 160:1085–1089.PubMedCrossRefGoogle Scholar
  13. 13.
    Antikainen RL, Jousilahti P, Vanhanen H, Ruomilehto J: Excess mortality associated with increased pulse pressure among middle-aged men and women is explained by high systolic blood pressure. J Hypertens 2000, 18:417–423.PubMedCrossRefGoogle Scholar
  14. 14.
    Benetos A, Zureik M, Morcet J, et al.: A decrease in diastolic blood pressure combined with an increase in systolic blood pressure is associated with a higher cardiovascular mortality in men. J Am Coll Cardiol 2000, 35:673–680. Important epidemiologic assessment of the respective importance of systolic versus diastolic BP in patient outcomes.PubMedCrossRefGoogle Scholar
  15. 15.
    Staessen JA, Gasowski J, Wang JG, et al.: Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet 2000, 11:865–872.CrossRefGoogle Scholar
  16. 16.
    Port S, Demer L, Jennrich R, et al.: Systolic blood pressure and mortality. Lancet 2000, 355:175–180.PubMedCrossRefGoogle Scholar
  17. 17.
    Staessen JA, Thijs L, Fagard R, et al.: Predicting cardiovascular risk using conventional versus ambulatory blood pressure in older patients with systolic hypertension. JAMA 1999, 282:539–546. First study that has demonstrated the prognostic relevance of ambulatory BP prospectively in an entirely untreated patient population.PubMedCrossRefGoogle Scholar
  18. 18.
    Verdecchia P, Schillaci G, Borgioni C, et al.: Ambulatory pulse pressure: A potent predictor of total cardiovascular risk in hypertension. Hypertension 1998, 32:983–988. First analysis that showed that ambulatory pulse pressure is superior to clinic pulse pressure in predicting cardiovascular morbidity.PubMedGoogle Scholar
  19. 19.
    Cruickshank JM: Coronary flow reserve and the J curve relation between diastolic blood pressure and myocardial infarction. BMJ 1988, 297:1227–1230.PubMedCrossRefGoogle Scholar
  20. 20.
    Black HR, Elliott WJ, Neaton JD, et al.: Baseline characteristics and early blood pressure control in the CONVINCE trial. Hypertension 2001, 37:12–18.PubMedGoogle Scholar
  21. 21.
    Hansson L, Zanchetti A, Carruthers SG, et al.: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998, 351:1755–1762.PubMedCrossRefGoogle Scholar
  22. 22.
    ALLHAT Collaborative Research Group: Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorhtalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 2000, 283:1967–1975. Important large, simple trial showing that doxazosin was less effective in controlling systolic BP compared with chlorthalidone, and was associated with a 19% increase in stroke rate.CrossRefGoogle Scholar
  23. 23.
    Prisant LM, Moser M: Hypertension in the elderly: can we improve results of therapy? Arch Intern Med 2000, 160:283–289.PubMedCrossRefGoogle Scholar
  24. 24.
    Bohmer F, Baronch R, Reinfruk J: Treatment of isolated systolic hypertension in the elderly with verapamil slow-release 240 mg. J Cardiovasc Pharmacol 1998, 12(Suppl 4):S45-S46.Google Scholar
  25. 25.
    Stallard MP, Park GD, Stewart WH: Systolic blood pressure response in three subgroups of hypertensives treated with sustained release diltiazem. J Cardiovasc Pharmacol 1998, 12(Suppl 6):S117-S119.Google Scholar
  26. 26.
    Leonetti G, Trimarco B, Collatina S: An effective approach for treating elderly patients with isolated systolic hypertension: results of an Italian multicenter study with fosinopril. Am J Hypertens 1997, 10(Suppl):230S-235S.PubMedCrossRefGoogle Scholar
  27. 27.
    Giles TD, Weber M, Bartels DW: Treatment of isolated systolic hypertension with labetalol in the elderly. Arch Intern Med 1990, 150:974–976.PubMedCrossRefGoogle Scholar
  28. 28.
    Epstein M, Menard J, Alexander J, Roniker B: Eplerenone, a novel and selective aldosterone receptor antagonist: efficacy in patients with mild to moderate hypertension [abstract]. Circulation 1998, 98:I–98-I–99.Google Scholar
  29. 29.
    Weber M: Emerging treatments for hypertension: potential role for vasopeptidase inhibition. Am J Hypertens 1999, 12:139S-147S.PubMedCrossRefGoogle Scholar
  30. 30.
    White WB: The systolic pressure versus pulse pressure controversy. Am J Cardiol 2001, 87:1278–1281.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • William B. White
    • 1
  1. 1.Section of Hypertension and Clinical PharmacologyUniversity of Connecticut School of MedicineFarmingtonUSA

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