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Systolic blood pressure: an underestimated cardiovascular risk factor
Giuseppe Mancia1, Gino Seravalle, Guido Grassi
1Departimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, University of Milano-Bicocca, Ospedale San Gerardo dei Tintori, Monza, Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy.
Insights
Systolic blood pressure is crucial for cardiovascular risk, especially in older adults. Achieving systolic blood pressure control is challenging but vital for reducing complications.
Area of Science:
- Cardiology
- Gerontology
- Pharmacology
Background:
- Historically, hypertension management focused on diastolic blood pressure.
- Systolic blood pressure is now recognized as equally important, particularly in elderly populations.
- Elevated systolic blood pressure significantly increases cardiovascular disease risk.
Purpose of the Study:
- To review evidence supporting the importance of systolic blood pressure in hypertension.
- To highlight the challenges in achieving systolic blood pressure control.
- To emphasize the need for improved treatments for systolic hypertension.
Main Methods:
- Review of epidemiological data on systolic blood pressure prevalence and risk.
- Analysis of clinical trial outcomes related to systolic hypertension treatment.
- Discussion of pathophysiological factors contributing to elevated systolic blood pressure.
Main Results:
- Isolated systolic hypertension is prevalent in the elderly and increases cardiovascular risk.
- Systolic blood pressure elevation is a key driver of cardiovascular risk, even in combined hypertension.
- Treatment of systolic hypertension effectively reduces cardiovascular complications.
- Systolic blood pressure control is less frequently achieved than diastolic control in hypertensive patients.
Conclusions:
- Systolic blood pressure is a critical determinant of cardiovascular risk and treatment efficacy.
- Achieving target systolic blood pressure levels is more challenging than diastolic levels.
- Further research into novel antihypertensive drugs and therapies is essential for improving systolic hypertension management.
Abstract:
Classification of the severity of hypertension and recommendations on the blood pressure values to be achieved during antihypertensive drug treatment have for decades been based on diastolic values. It is now clear, however, that systolic blood pressure is by no means less important. This paper will focus on the following sets of evidence: (1) that epidemiologically a selective elevation of systolic blood pressure has a major prevalence in the elderly population; (2) that isolated systolic hypertension carries a marked increase in the risk of cardiovascular disease and that even in systo-diastolic hypertension this risk may be more closely related to systolic than to diastolic blood pressure; (3) that treatment of systolic hypertension greatly reduces cardiovascular complications and that in all conditions this reduction is related to the treatment-induced reduction in systolic blood pressure to a degree similar to or superior to the relationship with the reduction in diastolic blood pressure; and (4) that in the hypertensive fraction of the population, control of systolic blood pressure is achieved much less often than control of diastolic blood pressure. That this last point is also the case in major intervention trials suggests that normalization of systolic blood pressure may be intrinsically more difficult than normalization of diastolic blood pressure, possibly because of the difficulty of reversing the pathophysiological abnormalities responsible for the elevation of systolic blood pressure. This emphasizes the importance of research into new drugs or treatment types with greater efficacy in systolic hypertension.