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Editorials |

Seniors and Systolic Hypertension : An Unanswered Call to Arms

John W. Graves, MD; Sheldon G. Sheps, MD, FCCP
Author and Funding Information

Affiliations: Rochester, MN 
 ,  Drs. Graves and Sheps are associated with the Division of Hypertension, at the Mayo Clinic and Foundation.

Correspondence to: John W. Graves, MD, Division of Hypertension, Mayo Clinic and Mayo Foundation, 200 First St SW, Rochester, MN 55905; e-mail: Graves.john@mayo.edu



Chest. 2001;119(2):323-327. doi:10.1378/chest.119.2.323
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Over half a century of research in hypertension therapy, an explosive growth in antihypertensive medications, and a marked increase in awareness of the complications of uncontrolled hypertension have not been matched by progressively improving hypertension control rates in the United States or worldwide. Rates of controlled hypertension (BP,< 140/90 mm Hg) range from a high of 27% (1994 US National Health and Nutrition Examination Study III1) to a low among European countries of approximately 6% (in the United Kingdom2). Elderly patients with isolated systolic hypertension (systolic BP, > 140 mm Hg; diastolic BP, < 90 mm Hg) are the demographic group least likely to have their BP controlled. Forty-one percent of all people > 65 years of age and 65% of African Americans > 65 years of age have uncontrolled systolic hypertension.3 This is particularly important as systolic BP is a better predictor of events such as coronary heart disease, stroke, congestive heart failure, renal failure, and all-cause mortality than is diastolic BP.4 Despite clear evidence of the marked increase in cardiovascular morbidity and mortality associated with poorly controlled systolic hypertension and consistent data from trials on the many benefits of lowering BP, changes in physician and patient behavior that would result in improved BP control have not occurred. Why haven’t rates of control of systolic BP improved? Multiple factors need to be considered.

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