Making Good Use of Diastolic and Systolic Blood Pressures in the Management of Hypertension

摘要

See related article, pp 1117–1123 In the modern era, physicians who wish to measure blood pressure for the management of hypertension are faced by many dilemmas and controversies. In the 1960s and 1970s it was very simple—use a mercury sphygmomanometer in the clinic, measure both the systolic blood pressures (SBPs) and diastolic blood pressures (DBPs), and base your decisions for managing the hypertension on the diastolic pressure. As time passed and the 20th century progressed, the situation became rapidly more complex. First, many new sphygmomanometers became available, aneroids and semitautomatic devices, and indeed, the mercury sphygmomanometer is now on death row in many countries. Then the clinic pressure came under severe criticism in view of issues, such as white coat or office hypertension and masked hypertension, leading to the increasing use of ambulatory blood pressure monitoring and the introduction of home blood pressure measurement, using a wide range of devices. The role of the physician in measuring the pressure also came under the spotlight. Over this period, the emphasis for determining the optimal blood pressure to measure moved progressively from the accuracy of the measurement itself to the accuracy and use of each measure in predicting the risk of major cardiovascular events, both fatal and nonfatal. As a result, the systolic pressure has come to be preferred over the diastolic pressure.1 In large part, this has reflected the changes attributable to the ageing of the population with progressive stiffening of the large arteries leading to a situation in which the SBP continues to rise with age, whereas the diastolic pressure reaches a peak around the age of 50 years …