UNCERTAINTY exists as to the appropriate goal of antihypertensive therapy that will provide maximal protection for the majority of patients. In particular, recently published data show an increase in cardiovascular events in elderly patients with isolated systolic hypertension whose diastolic levels were inadvertently lowered to below 65 mm Hg by therapy. Whether such a J-curve exists for those with combined systolic and diastolic hypertension is less certain.
Whereas the goal of 140/90 mm Hg seems appropriate for relatively low-risk hypertensive patients, more intensive therapy to reach a goal below 130/80 mm Hg is indicated for those with high-risk hypertension, including those with diabetes or renal insufficiency. Caution is needed if diastolic levels go below 65 mm Hg in those with isolated systolic hypertension.