摘要：

SUMMARY Diastolic hypertension hasbeenwidely andjustifiably accepted as a causeofcardiovascular mortality. However, ithasalso beenaccepted thatthecardiovascular sequelae ofhypertension derive chiefly fromthediastolic component. Because systolic anddiastolic pressureareusually highly correlated itisnot easytodissociate theeffects ofeach. Statistical analysis suggests thatsystolic pressureisactually themore potent contributor tocardiovascular sequelae. Evenisolated systolic pressureelevation isassociated with an excesscardiovascular mortality. Atlowdiastolic pressures(i.e., < 95mm Hg),risk rises withthelevel of systolic pressure.Also, isolated systolic hypertension ismostominous intheelderly, inwhomitishighly prevalent. Isolated systolic hypertension wasrelated tothe occurrenceof"direct" complications aswell astoathero- sclerotic sequelae. Itwas also associated with excessmortality, taking into account rigid vessels asjudged frompulse-wave recordings. Trials todetermine whether thetreatment ofisolated systolic hypertension is efficacious foravoiding its demonstrated excesscardiovascular morbidity andmortality areurgently needed. ELEVATEDBLOODPRESSUREisrecognized asa powerful precursor ofthemajor cardiovascular dis- eases, including coronary heartdisease, cerebro- vascular disease, cardiac failure andocclusive peripheral arterial disease.1-3 Although blood pressure isanacknowledged risk factor forcardiovascular dis- ease, itistaught clinically andtheconviction ofmost physicians isthat thediastolic component isthechief determinant ofthecardiova, "-arsequelae ofhyper- tension.4-6 Thelevel ofdiastbrL: pressure rather than thelevel ofsystolic pressure isthecurrent indication fortreatment ofhypertension.7 Thereis,however, abundant evidence that boththesystolic anddiastolic components oftheblood pressure predict theoc- currence ofcardiovascular disease.'-" Epidemiologic evidence indicates thatsystolic pressure maybea better predictor thandiastolic pressure formostcar- diovascular sequelae ofhypertension.9 Theimportance ofisolated systolic hypertension as aprecursor ofcardiovascular disease remains contro- versial despite increasing evidence relating ittocar- diovascular morbidity andmortality.10 Inthis report wepresent dataonisolated systolic hypertension in theFramingham cohort. Dataarepresented onthe prevalence ofisolated systolic hypertension andonthe relation ofisolated systolic hypertension tothein- cidence ofcardiovascular disease.

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