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[Isolated systolic hypertension in the elderly]
1Facoltà di Medicina e Chirurgia, Dipartimento di Medicina Sperimentale e Clinica, Cattedra e Scuola di Specializzazione in Geriatria, Policlinico Materdomini, Università degli Studi, Catanzaro, Italy.
Insights
Isolated systolic hypertension is common in older adults and a risk factor for cardiovascular disease. Effective treatment involves lowering systolic blood pressure while preserving diastolic pressure, with specific medications showing promise.
Area of Science:
- Geriatric Medicine
- Cardiovascular Research
- Pharmacology
Context:
- Isolated systolic hypertension (ISH) is the predominant form of hypertension in the elderly population.
- ISH is recognized as an independent risk factor for significant cardiovascular morbidity and mortality.
Purpose:
- To review the prevalence, pathophysiology, diagnosis, and treatment strategies for isolated systolic hypertension in the elderly.
- To highlight optimal therapeutic approaches for managing ISH, focusing on systolic and diastolic blood pressure targets.
Summary:
- The review emphasizes that the ideal treatment for ISH aims to maximize systolic blood pressure reduction while minimizing diastolic blood pressure reduction.
- Antihypertensive agents, particularly calcium antagonists, ACE-inhibitors, and angiotensin II antagonists, are noted for their efficacy in improving large artery stiffness, making them suitable for elderly patients with ISH.
- Careful patient evaluation and consideration of polypharmacy are crucial for selecting appropriate medications and avoiding adverse drug interactions.
Impact:
- Provides a comprehensive overview of ISH management in the elderly.
- Guides clinicians in selecting effective antihypertensive agents for ISH, considering vascular properties and patient-specific risk factors.
- Underscores the importance of individualized treatment plans to mitigate cardiovascular risks associated with ISH.
Abstract:
Isolated systolic hypertension is the most common type of hypertension in the elderly. A number of trials have widely shown that it is an independent risk factor for cardiovascular morbidity and mortality. This review focuses the prevalence of isolated systolic hypertension, its pathophysiology, diagnosis and treatment. The optimal treatment strategy is to maximize reduction in systolic blood pressure and to minimize reduction in diastolic blood pressure. All classes of antihypertensive agents can be used, but calcium antagonists, ACE-inhibitors and, more recently, the angiotensin II antagonists appear to be more successful in improving large artery stiffness and therefore are especially useful in treating isolated systolic hypertension in the elderly. A careful evaluation and treatment has to be made in particular in those patients with more risk factors, in order to choose the most appropriate drug and to avoid dangerous drug-drug interactions where polypharmacy occurs.