This article provides a descriptive survey of the problem of systolic hypertension. Throughout, 2 types of systolic hypertension will be described: isolated systolic hypertension, which is the most common type of elevated blood pressure in the elderly, and uncontrolled but treated hypertension, which is characterized by elevations in systolic blood pressure (SBP) that are substantially greater than elevations in diastolic blood pressure (DBP). The population variance in SBP vastly exceeds that observed in DBP. The distinction between the 2 aspects of SBP is largely semantic and based upon the somewhat arbitrary blood pressure classification schemes. In this discussion, untreated or uncontrolled hypertension refers to SBP z140 mm Hg and/or DBP z90 mm Hg, as specified in The Sixth Report of the Joint National Committee (JNC-VI) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. We will start with a brief survey of the demographics and epidemiology of the population with systolic hypertension. We then review the epidemiologic and observational data on the risk associated with systolic hypertension. Within this section, we focus on the risk associated with pulse pressure (PP) (=SBP DBP), which has special relevance to the isolated systolic hypertension population. We will explore the results of treatment trials that address control of systolic hypertension. Finally, we address the challenges of blood pressure control concentrating on risk reduction. Physician habits are addressed in this context. With greater appreciation of the dangers of systolic hypertension, physicians may improve the quality of care they provide.