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October 10, 1994

Isolated Systolic HypertensionAnother Disincentive to Treatment Is Removed

Arch Intern Med. 1994;154(19):2128-2129. doi:10.1001/archinte.1994.00420190015003

UNTIL RECENTLY, whenever I lectured on hypertension I could expect to be frustrated by my inability to answer questions about isolated systolic hypertension (ISH) with authority derived from a scientific database. Indeed, it is not that many years ago that systolic blood pressure was considered to be normal if it were less than the patient's age plus 100 and there was considerable disincentive to attempt to treat it.

In 1976, Jackson et al1 described six patients aged 64 to 84 years who had been harmed by treatment of their hypertension. Pretreatment blood pressure readings ranged from 160 to 220 mm Hg systolic and from 80 to 120 mm Hg diastolic. They cited articles implying that systolic levels of up to 220 mm Hg can be found in healthy old people, that diastolic pressures of up to 120 mm Hg in symptomless elderly hypertensive subjects are not an indication for

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