UNSOLVED PROBLEM: (ISOLATED) SYSTOLIC HYPERTENSION WITH DIASTOLIC BLOOD PRESSURE BELOW THE SAFETY BORDER.

: The problem with high sBP combined with low dBP requires attention because sBP is directly and continuously related to the most important criterion - all-cause mortality - whereas dBP becomes inversely related to it after the age of 50-60 years. The 2018 European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) guidelines for hypertension (HTN) are very helpful to recommend a lower level of safety of in-treatment dBP. To prevent tissue hypoperfusion, HTN guidelines recommend that dBP should be ≥70 mmHg on-treatment. A patient with very elevated sBP (e.g., 220 mmHg) and low dBP (e.g., 65 mmHg) is difficult to treat if one strictly follows the guidelines. In this situation, sBP is a clear indication for antihypertensive treatment, but a relative contraindication is dBP (being lower than 70 mmHg, a recognized safety border by 2018 ESC/ESH guidelines). The dilemma about whether to treat (isolated) systolic hypertension ((I)SH) patients with low dBP (<70 mmHg) or not is evident by the fact that almost half of them (45%) remain untreated. This is a common occurrence and identifying this problem is the first step to solving it. We suggest that an adequate search and analyses ought to be performed to solve this issue, starting from the exploration of prognosis of (I)SH subset with too low dBP (<70 mmHg) at the beginning of already performed randomized clinical trials.