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Clinical Import of Systolic Hypertension

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Research Division, Cleveland Clinic Foundation; Cleveland, Ohio

Ann Intern Med. 1978;88(3):426-427. doi:10.7326/0003-4819-88-3-426
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In this issue, Rabkin, Mathewson, and Tate (1) add to the chain that links systolic hypertension to major cardiovascular accidents. This evidence has been slowly developing since Gubner (2) pointed out the pathogenetic importance of elevated systolic pressure. Prospective epidemiologic studies confirmed these earlier impressions; cardiac enlargement (3), heart failure (4), coronary arterial disease (5), and strokes (6) were all more closely related to systolic than diastolic levels of pressure. Similar results were obtained in analyses of cardiac (ECG) response to antihypertensive therapy (7).

Despite these observations, systolic blood pressure levels continue to be relatively neglected both in practice and


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