Isolated Systolic

The association between hypertension and a “hardening ” of the pulse and apoplexy has been recognized for hundreds of years. The major problem in elderly people is isolated systolic hypertension (ISH), defined as a raised systolic pressure but normal diastolic pressure. It affects around half of people aged over 60 years1. Originally, because isolated systolic hypertension was so common it was considered part of ageing and, like essential hypertension, benign. However, there is now compelling evidence from cross sectional, longitudinal, and randomized controlled trials that show that isolated systolic hypertension confers a substantial cardiovascular risk2,3. Despite this, it remains under-diagnosed and largely untreated4. The roots of this lie in a century of over-reliance on the importance o