[Reflected wave and isolated systolic hypertension: problems of pathogenesis and therapy]

The value of reflected (tidal) wave amplitude in the pathogenesis of isolated systolic hypertension (ISH) is discussed and main characteristics of elastic properties of arteries (compliance, distensibility, rigidity, pulse wave velocity, and amplitude of reflected wave) are considered. In ISH systolic and pulse blood pressures are associated with augmentation of the reflected wave amplitude. Increased pulse wave velocity characteristic of ISH leads to displacement of reflected wave from diastole to systole. Summation of two waves (primary and reflected) causes elevation of systolic blood pressure. Choice of antihypertensive drugs for the treatment of ISH is determined by their action on pulse wave velocity, delay of reflected wave and arterial compliance. Preferable agents are angiotensin converting enzyme inhibitors, calcium antagonists, diuretics and beta-blockers with vasodilating properties. In bradycardia with high stroke volume normalization of heart rate can be achieved by M-anticholinergic drugs and theophylline.