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Editorial
December 8/22, 2003

Overcome Clinical Inertia to Control Systolic Blood Pressure

Arch Intern Med. 2003;163(22):2677-2678. doi:10.1001/archinte.163.22.2677

GENERATIONS OF physicians have learned in lecture halls and clinics that normal blood pressure (BP) is less than 140/90 mm Hg. During the past 30 years, an unending stream of effective hypertension medications has been developed and marketed, and classic epidemiologic studies and clinical trials have demonstrated again and again the importance of aggressive treatment of hypertension.

But what do we do when one number is at goal and the other is not? It is clear that in individuals younger than 50 years, diastolic BP (DBP) is the better predictor of future complications of hypertension, whereas in those 50 years and older, systolic BP (SBP) is a better predictor of future complication risk.1 Most individuals with hypertension are 50 years or older, and for these patients, SBP control is a high priority, even in the face of a perfectly normal DBP reading.2,3 In fact, Framingham data indicate that SBP alone correctly classifies hypertensive status in approximately 98% of adult patients.46

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