Systolic hypertension in the elderly. Pathophysiology and management

Isolated systolic hypertension occurs with increased prevalence in the elderly population. It is characterized by reduced vascular compliance, often combined with increased peripheral resistance. These changes are not specific to patients with systolic hypertension, occurring, perhaps to a lesser extent, in the normotensive aging population as well. Systolic hypertension is associated with a risk of cardiovascular morbidity and mortality that possibly exceeds that associated with systolic-diastolic hypertension. However, until the recent report of the Systolic Hypertension in the Elderly Program, the benefit of treatment of this population was undocumented. The Systolic Hypertension in the Elderly Program demonstrated that lowering of blood pressure with a diuretic, combined, when necessary, with a beta blocker, reduced the rate of myocardial infarction and stroke. Other agents may also be effective in lowering blood pressure, although their ability to reduce cardiovascular morbidity and mortality in this population remains to be documented. The results suggest that pharmacologic treatment be considered for patients older than 60 years whose systolic blood pressure remains above 160 mm Hg (with a diastolic pressure below 90 mm Hg). Whether treatment should be recommended for all patients with systolic hypertension, or, alternatively, for only those at higher risk for cardiovascular events, remains controversial.