Hypertension remains one of the most commonly encountered clinical conditions and one that health care providers can effectively treat. At least two intervention trials have demonstrated clinical benefits as a consequence of reduction of diastolic blood pressure greater than 90 mm Hg in individuals 60 years of age or older.1-3 Systolic blood pressure elevation remains more problematic, even though most would agree that systolic hypertension is at least an equal culprit in the production of cardiovascular complications, but unfortunately no intervention trial data are presently available to support aggressive treatment. Reduction of blood pressure in those at highest risk (systolic blood pressure, >180mm Hg) and in those with concomitant coronary artery disease, congestive heart failure, left ventricular enlargement, or retinopathy seems appropriate, whereas intermediate systolic levels between 160 and 180 mm Hg require a more individualized approach.4
See also p 673.
All of the therapeutic recommendations that are