The purpose of this study was to examine the prevalence of a positive Osler's manoeuver (OM) among persons screened for the Systolic Hypertension in the Elderly Program (SHEP). Information obtained from all individuals included age, gender, and race; history of antihypertensive, anticoagulant, insulin, or cardiac pacemaker use; and history of heart attack, coronary bypass surgery, or stroke. Among the persons aged 60 and over that were screened for eligibility at the Louisville SHEP Center, OM was performed on 3387 subjects. Of these, 7.2% (243 of 3387) were determined to be Osler maneuver positive (O+). O+ was more prevalent among males than among females (P = 0.025). A higher prevalence of O+ was associated with both higher age (P < 0.001) and higher blood pressure (P < 0.001). There were significantly more Osler positives among those who responded positively to 'Have you had a stroke?' (P = 0.007) and 'Are you taking anticoagulants' (P = 0.044) than among those who responded negatively to these questions. O+ was also less prevalent among those that were normotensive at the time of the screening (P = 0.046). The results of this study, when taken with those of previous studies of OM, support the cautious use of OM as a screening tool for pseudohypertension in the elderly population and as an adjunct in determining the cardiovascular risk profile of individual patients. However, further study of OM is required before it can be recommended for routine use in the assessment of hypertension among the elderly.