The first report of the systolic and pulse pressure (SYPP) working group

• Currently, only one in four hypertensives have their blood pressure controlled to < 140 mmHg systolic and < 90 mmHg diastolic. • Evidence suggests that controlling both SBP and DBP are important in preventing stroke, CVD, and renal disease. • The approach to treating elevated SBP, as well as the likely benefits of this treatment, are similar in patients with both systolic/diastolic hypertension and with ISH. The focus should be narrowed to the concept of treating the 'high systolic pressure' rather than using the term 'systolic hypertension,' which may be taken to mean only ISH. • It is almost certain that if the high SBP becomes the primary target of treatment, similar benefits in those patients who also have diastolic hypertension will like-wise occur. • Because of substantial variability in measurements of SBP in individual patients, it is important to obtain multiple measurements (at least three) before establishing the diagnosis. • An SBP of ≥ 160 mmHg should always be treated, regardless of the patients' age. Young patients with this blood pressure and/or a wide PP should be evaluated for possible causes of a hyperkinetic state. • Since an SBP < 140 mmHg is optimal, patients between 140 and 159 mmHg are candidates for therapy, but we must bear in mind that the clinical benefits have not yet been confirmed by clinical trials. • In patients with diabetes mellitus, a still lower goal (< 130 mmHg) may be appropriate, but again we must remember that definitive endpoint data from clinical trials are not yet available. • The presence of a low or very low DBP does not obviate the need for treatment of a high SBP. In fact, this finding dictates an especially aggressive approach to therapy of high SBP. • Selection of a first agent for individual patients should follow the recommendations suggested by the WHO/ ISH and the JNC VI guidelines. • Monotherapy, even in full doses, will not often get patients to goal. There is a need for newer drugs that reduce SBP more effectively. • Currently, it will often be necessary to combine two or more antihypertensive agents to reach goal blood pres-sures in many patients. Careful selection of low-dose therapies can facilitate good blood pressure control without adverse effect, and may even offer the potential of improving quality of life measures during therapy. • There is a need for public and professional education to obtain wide acceptance of the concept that high SBP should be regarded as the predominant basis for the diagnosis and treatment of hypertension.