-While the specialty debates whether 120 or 140 mm Hg is the appropriate treatment target, the emphasis on a
goal remains unchallenged.
However, the inaugural national guidelines -
JNC 1 in 1977
established diagnostic and treatment thresholds according to diastolic pressures. It was not until the 1993 position statement - JNC V - that systolic values figured prominently. This paper by Neaton was among those that prompted this transition.
-While the study population consisted entirely of caucasian men under age 60, these findings have been reproduced in women, minorities, and the elderly and for outcomes such as all-cause mortality and stroke.
-The "vintage" of this paper should not be viewed as a shortcoming. Through the examination of a cohort recruited in the 1970s, the authors captured a population free of anti-hypertensive, lipid-lowering, and glucose-controlling therapies. This allowed the natural history of cardiovascular disease to reveal itself.
-While the predictive value of models incorporating multiple parameters (systole, diastole, and pulse pressure) are more robust still, the BP generated during systole remains the single most prognostic variable.
-Disclosures: I have no conflicts to declare.