Should the target for blood pressure control specify both a systolic and a diastolic component?

Abstract

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Report recommends, as the target for hypertension control, achieving both a systolic and diastolic goal. We suggest, however, that specifying both a systolic and a diastolic component for the blood pressure goal can be confusing to physician and patient. Furthermore, literal interpretation and application of this JNC 7 recommendation could result in overtreatment, undertreatment, or institution of treatment for hypertension when none is needed. Specific scenarios illustrating how inappropriate treatment could result from literal interpretation and application of the JNC 7 recommendations are presented. Our recommended blood pressure goal for hypertensives is: Sitting systolic blood pressure consistently in the 120s or less, if tolerated. This recommendation is evidence based, easy to understand, and achievable. Its rationale is discussed.