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Hypertension is a risk factor for cardiovascular (CV) diseases, either coronary artery disease (CAD), peripheral artery disease (PAD) or cerebrovascular disease (CVD). The relationships between those different localizations of CV disease and the haemodynamic features of hypertension have been poorly evaluated in the past. In the ATTEST study, a geographically representative panel of 3020 general practitioners recruited 8316 consecutive patients with CV diseases (PAD, CAD or CVD, alone or in association). Blood pressure, which was not an inclusion criterion, was then measured and related to the different forms of CV diseases. Blood pressure classification involved 20% normotensive subjects, 24% subjects with controlled hypertension, 42% subjects with isolated systolic hypertension and 14% subjects with systolic–diastolic hypertension, all hypertensives with or without antihypertensive therapy. From multiple regression analysis, it appeared that subjects with systolic hypertension were characterized by the presence of PAD, with little or no presence of CAD and/or CVD. Subjects with systolic–diastolic hypertension were characterized by the presence of CAD and/or CVD, but without PAD. Although the former was only influenced by age, dyslipidaemia and diabetes mellitus influenced the latter. This study confirms the high prevalence of hypertension (80%) in a large population of patients with CV diseases selected in primary care. Analysis of different features of hypertension revealed that isolated systolic hypertension was the most prevalent form of hypertension in this treated population. Finally, one of the predominant goals of secondary prevention in subjects with PAD should be the treatment of isolated systolic hypertension.Journal of Human Hypertension (2009) 23, 182–187; doi:10.1038/jhh.2008.121; published online 2 October 2008 [ABSTRACT FROM AUTHOR]

Long-term population surveys and studies of untreated hypertensive patients both strongly suggest that over the age of about 45, the height of the systolic blood pressure is a better predictor of cardiovascular outcome than the diastolic pressure. Research into echocardiographic left ventricular size, endothelial function and thromborheology also back up this supposition. In clinical practice, the treatment of isolated systolic hypertension has been shown to be very worthwhile. There remains some uncertainty as to the relative significance of diastolic blood pressure when it is frankly high, as in severe systo-diastolic hypertension. However some clinicians and epidemiologists have questioned whether diastolic pressure is still worth measuring, given the overwhelming importance of the height of the systolic blood pressure at predicting outcome. [ABSTRACT FROM AUTHOR]