Abstract

Background.Systolic blood pressure (SBP) is even more important than diastolic blood pressure (DBP) with regard to the risk of cardiovascular complications. Methods and Results.Pitfalls in the diagnosis of systolic hypertension include the auscultatory gap, use of the proper size cuff (obese adult size for mid-arm circumference >33 cm and child's cuff for mid-arm circumference <23 cm), a “white coat” effect of about 17 mm Hg, regression toward the mean, and a tendency to focus only on hypertension rather than all of the cardiovascular risk factors. Pitfalls in the pharmacologic management of systolic hypertension include being too aggressive with “acute” therapy, too fast in up-titration, too complacent about adverse effects, too unaware of important drug or food interactions, and too content with the achieved level of SBP. Conclusion.In treated hypertensives, SBP is typically less well controlled than DBP. Clinicians must not generally be content with partial control of SBP.