Organ damage, hypertension-related

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]. 

The patient may have a previous medical history or diagnostic findings that indicate the presence of hypertension-related target-organ damage ... 

Hypertension often presents as isolated systolic hypertension in the elderly. Epidemiologic data indicate that cardiovascular morbidity and mortality are more closely related to SBP than to DBP in patients aged 50 years and older, so this population is at high risk for hypertension-related target-organ damage. Although several placebo-controlled trials have specifically demonstrated risk reduction in this form of hypertension, many older people with hypertension are either not treated or treated yet not controlled. ... 

Hypertension affects African-American patients at a disproportionately higher rate, and hypertension-related target-organ damage is more prevalent than in other populations. The reasons for these differences are not fully understood. Differences in electrolyte homeostasis, GFR, sodium excretion and transport mechanisms, plasma renin activity, and BP response to plasma volume expansion may explain the higher prevalence but do not account for the increased severity. The African-American population has comparatively low plasma renin activity and increased BP response to sodium and fluid loading. 

---