Related Experiment Videos
Understanding and Managing Isolated Systolic Hypertension in the Elderly
1Hypertension Clinic and Cardiology Section, Department of Medicine, VA Medical Center and University of Minnesota Medical School, Minneapolis, MN.
Insights
Isolated systolic hypertension (ISHT) in older adults stems from stiff arteries and high vascular resistance. Effective antihypertensive treatments can prevent strokes, but careful blood pressure management is crucial to avoid risks like the J-curve phenomenon.
Area of Science:
- Cardiology
- Gerontology
- Vascular Medicine
Background:
- Isolated systolic hypertension (ISHT) is common in the elderly.
- It results from increased systemic vascular resistance and arterial stiffening.
- Early return of reflected pulse waves can increase systolic blood pressure and left ventricular systolic stress.
Purpose of the Study:
- To understand the mechanisms of ISHT in the elderly.
- To evaluate the effectiveness and limitations of antihypertensive therapy for ISHT.
- To identify ideal pharmacological targets for ISHT treatment.
Main Methods:
- The abstract discusses the physiological mechanisms of ISHT.
- It reviews existing evidence on antihypertensive therapy for ISHT.
- It considers the impact of arterial stiffness on baroreceptor function.
Main Results:
- Antihypertensive therapy is effective in preventing strokes associated with ISHT.
- Excessive reduction in diastolic blood pressure may limit benefits and cause myocardial issues (J-curve).
- Diuretics and long-acting nitrates show effectiveness in lowering SBP and improving LV systolic stress.
Conclusions:
- ISHT in the elderly is multifactorial, involving vascular resistance and arterial stiffness.
- Antihypertensive therapy requires careful management to balance benefits and risks.
- Ideal treatments should target vascular resistance, arterial compliance, and pulse wave reflection.
Abstract:
In summary, ISHT in the elderly is a result of the interaction of increased systemic vascular resistance and of progressive arterial stiffening. The early return of reflected pulse wave may add to peak SBP in the ascending aorta and central arteries, thereby increasing LV systolic stress (afterload). Antihypertensive therapy has been shown to be effective in the prevention of strokes associated with ISHT. The reduction in the incidence of fatal and non fatal MI by active treatment may be limited by excessive lowering of DBP, resulting in inadequate myocardial perfusion in some patients (J-curve). The ideal drug for the treatment of ISHT should reduce systemic vascular resistance, increase large artery compliance, and delay the return of reflected wave in central arteries. Diuretics effectively lower SBP in the elderly with ISHT. Long-acting nitrates lower SBP selectively and have a favorable effect on LV systolic stress (afterload). Baroreceptor dysfunction due to increased arterial stiffness increases the risk of orthostatic and postprandial hypotension in the elderly during antihypertensive therapy.