Evaluating Mean Blood Pressure as a Potential Therapeutic Target in Systolic Hypertension with Too Low Baseline Diastolic Blood Pressure

INTRODUCTION: Isolated systolic hypertension (ISH) has a high mortality rate and a high prevalence of hypertension-mediated organ damage (HMODs). The aims of this paper are: (1) to search arterial hypertension (HTN) guidelines to determine whether mean blood pressure (BP) is mentioned as a treatment target for ISH patients with too-low pre-treatment dBP, and (2) to analyze whether there is a rationale for suggesting mean BP as a potential antihypertensive treatment target. METHODS: We performed a search for HTN guidelines in Scopus, the Medline database, Springer Nature, Cambridge University Press, Oxford University Press, and Wiley-Blackwell. The scholarly search engine Google Scholar was also used. RESULTS: Mean BP is already used to guide BP treatment in numerous settings, mostly in intensive care units, and guidelines recognize that mean BP can be used in several clinical scenarios to evaluate antihypertensive treatment. However, mean BP is not mentioned in half of the guidelines, and none of the 40 HTN guidelines mention mean BP as a chronic treatment target in ISH. DISCUSSION: The main finding of this narrative review is that the problem of ISH with a too-low baseline dBP has been clearly identified but remains unresolved. This paper does not offer a definitive answer but presents an initial approach to addressing the problem. CONCLUSION: The problem of ISH with too-low dBP is clinically relevant, and such patients are difficult to treat. We propose mean BP for investigation and evaluation as a means of adjusting the intensity of antihypertensive treatment in large patient populations with ISH and too-low dBP.