Isolated systolic hypertension: a new challenge in medicine

In the elderly, isolated systolic hypertension (ISH) is a particularly good predictor of subsequent cardiovascular events. The purpose of this article is to review the evidence provided by the Systolic Hypertension Elderly Program (SHEP) and the Systolic Hypertension in Europe Study (Syst-Eur) on the benefits of lowering systolic blood pressure (SBP) and to report on the preliminary findings of the Maracaibo Aging Study (MAS) on ISH. These two trials, the SHEP using chlorthalidone and atenolol as step 2 and the Syst-Eur using nitrendipine and hydrochlorothyazide as step 2, demonstrated a decrease of more than 30% for all cardiovascular complications, including stroke and coronary events. MAS is a population-based study that included all the subjects older than 55 years of age that resided in a defined area of the city of Maracaibo. There was a high prevalence of ISH (45.7%) being higher among women than in men, and significantly increased with advancing age. SBP was associated with dementia when it was measured by an ambulatory blood pressure monitor (ABPM), while there was no association when it was assessed by the casual method. Diastolic blood pressure (DBP) as casual or measured by ABPM was not related to dementia. In conclusion, ISH is a serious public health problem and benefits from lowering elevated SBP to reduce the risk of cardiovascular events. It was shown there was a strong correlation between high SBP and cognitive dysfunction and this was best demonstrated by using ABPM. Research should address the impact of using modern diagnostic tools and to compare the efficacy of the different types of antihypertensive drugs.