Which Is More Important: Systolic Hypertension or Diastolic Hypertension?

J. Willis Hurst, MD


January 23, 2003


Until recently, physicians assumed that diastolic hypertension was more serious than systolic hypertension. I have been receptive to the changing view because one of my thinking colleagues pointed out to me some 30 years ago that elevated systolic blood pressure would seem to play more of a role in the development of left ventricular hypertrophy and stroke than high diastolic blood pressure. Now there is considerable evidence to support the concept that systolic hypertension is a good predictor of future cardiovascular disease.

In a recent issue of Archives of Internal Medicine, Benetos and colleagues[1] reported that the control of systolic blood pressure was more important than the control of diastolic blood pressure in hypertensive men. They further stated that diastolic blood pressure was of little value in predicting future cardiovascular risk.

In an editorial in the same issue, Prakash Deedwania[2] supported this viewpoint, but called for the development of better drugs to control the elevation of systolic blood pressure and an extensive educational program devoted to this shift of emphasis.