The Relative Importance of Focusing on Elevations of Systolic vs Diastolic Blood Pressure

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Abstract
Since the invention of indirect auscultatory sphygmomanometry at the turn of the century, physicians have tended to focus more on treating elevations of diastolic blood pressure (DBP) than elevations of systolic blood pressure (SBP). As described by Rutan et al,1 the primary focus on DBP resulted from theoretical concerns that the level of DBP was more related to end organ damage. Also, as mentioned by Mann2 in the review article in this edition, the original Veterans Affairs Cooperative Study, the first to prove benefit in treating high blood pressure, focused on DBP. The fact that SBP rises on average throughout the life span in industrialized societies gave impetus to the notion that elevation of SBP was an aging-related phenomenon attributable to decreased compliance of the major arteries. A common clinical dictum for years was that a normal SBP for older persons was "100 plus the person's age." Therefore,