Isolated systolic

Finally, drug treatment in the elderly is of great importance and warrants special attention with regard to safety and tolerability, since systolic blood pressure is recognized as an important target for treatment, particularly in older persons. The benefits of antihypertensive treatment in the elderly and in patients with isolated systolic hypertension are greater than in younger persons. 

As a result of such studies hypertension has been operationally defined as the blood pressure level above which therapeutic intervention has clinical benefit. As increasingly aggressive intervention has continued to demonstrate benefits, this level has gradually reduced over time and is commonly defined as systolic blood pressure>l40 mmHg and/or diastolic blood pressure >90 mmHg (Table 1). Isolated systolic hypertension is defined as systolic blood pressure >140 mmHg and diastolic blood pressure <90 mmHg. 

In most individuals, the systolic pressure increases sharply with age, whereas the diastolic pressure increases until about age 55 years and then declines. Older individuals with an elevated systolic pressure have a condition known as isolated systolic hypertension (ISH). When the systolic pressure is high, blood vessels become less flexible and stiffen, leading to cardiovascular disease and kidney damage. Research indicates that treating ISH saves lives and reduces illness. The treatment is the same for ISH as for other forms of hypertension. 

The treatment of elderly patients with hypertension, as well as those with isolated systolic hypertension, should follow the same approach as with other populations with the exception that lower starting doses may be warranted to avoid symptoms and with special attention paid to postural hypotension. This should include a careful assessment of orthostatic symptoms, measurement of blood pressure in the upright position, and caution to avoid volume depletion and rapid titration of antihypertensive therapy.2 In individuals with isolated systolic hypertension, the optimal level of diastolic pressure is not known, and although treated patients who achieve diastolic pressures less than 60 to 70 mm Hg had poorer outcomes in a landmark trial, their cardiovascular event rate was still lower than those receiving placebo.69... 

HbAlc Glycosylated hemoglobin (hemoglobin Alc) ISH Isolated systolic hypertension... 

Patients with diastolic blood pressure (DBP) values <90 mm Hg and systolic blood pressure (SBP) values >140 mm Hg have isolated systolic hypertension. 

Elderly patients may present with either isolated systolic hypertension or an elevation in both SBP and DBP. Epidemiologic data indicate that CV morbidity and mortality are more closely related to SBP than to DBP in patients 50 years of age and older. 

Staessen JA, Gasowski J, Wang JG, Thijs L, Den Hond E, Boissel IP et al. Risks of untreated and treated isolated systolic hypertension in the elderly meta-analysis of outcome trials. Lancet 2000 355(9207) 865-72. 

Long-acting only Isolated systolic hypertension Heart failure... 

Liu L, Wang JG, Gong L, Liu G, Staessen JA, for the Sys-tohc Hypertension in China (Syst-China) Collaborative Group. Comparison of active treatment and placebo for older Chinese patients with isolated systolic hypertension. J Hypertens 1998 16 1823-9. 

SHEP Co-operative Research Group Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension final results of the Systolic Hypertension in the Elderly Programme (SHEP). JAMA 1991 265 3255-64. 

Thus, the physician must establish with certainty that hypertension is persistent and requires treatment and must exclude secondary causes of hypertension that might be treated by definitive surgical procedures. Persistence of hypertension, particularly in persons with mild elevation of blood pressure, should be established by finding an elevated blood pressure on at least three different office visits. Ambulatory blood pressure monitoring may be the best predictor of risk and therefore of need for therapy in mild hypertension. Isolated systolic hypertension and hypertension in the elderly also benefit from therapy. 

The issues of whether hyperuricemia is an independent risk factor for cardiovascular disease and the clinical relevance of the rise in serum uric acid caused by diuretic treatment are controversial (SED-14, 660 351). In the Systolic Hypertension in the Elderly Program (SHEP), diuretic-based treatment in 4327 men and women, aged 60 years or more, with isolated systolic hypertension was associated with significant reduction in cardiovascular events (SED-14, 657). Serum uric acid independently... 

Taubert D, Berkels R, Roesen R, Klaus W. 2003. Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. JAMA 290 1029-1030. 

SBP) was seen with candesartan, and the smallest with eprosartan. The control of SBP attracts more attention from the fact that SBP is more closely related to target organ damage than DBP. The beneficial effects of ARBs in patients with isolated systolic hypertension have been well-documented by the LIFE (losartan), Val-Syst (valsartan), and SCOPE (candesartan) studies [26-28]. 

Pendlebury ST (2007). Worldwide under-funding of stroke research. International Journal of Stroke 2 80-84 Petrovitch H, Curb D, Bloom-Marcus E (1995). Isolated systolic hypertension and risk of stroke in Japanese-American men. Stroke 26 25-29... 

Sagie A, Larson MG, Levy D (1993). The natural history of borderline isolated systolic hypertension. New England Journal of Medicine 329 1912-1917... 

Another study examined the effects of CoQlO on what s called isolated systolic hypertension in which only the systolic, not the diastolic, pressure is elevated. A group of forty-six men and thirty-seven women got either 60 mg of CoQlO daily or a placebo for twelve weeks. People taking the CoQlO had decreases in systolic blood pressure from 10.5 to a whopping 25.1, with an average of 17.8. That s wonderful, but not all studies have shown such dramatic improvements. 

Another study, from the Baker Heart Research Institute in Melbourne, Australia, showed that folic acid supplementation for just three weeks reduces both blood pressure in the brachial artery of the arm and arterial stiffness. The investigators concluded that Folic acid is a safe and effective supplement that targets large artery stiffness and may prevent isolated systolic hypertension. ... 

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