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Systolic hypertension in the elderly
1Division of Clinical Pharmacology/Hypertension, University of Pittsburgh, PA 15261.
Insights
Isolated systolic hypertension (ISH) is increasingly prevalent in aging populations and linked to higher risks of stroke and heart disease. The Systolic Hypertension in the Elderly Program (SHEP) trial is evaluating antihypertensive therapy for ISH.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Diastolic blood pressure (BP) historically guided hypertension treatment, but systolic BP is increasingly recognized as a risk factor.
- Systolic BP selectively rises with age, leading to a higher prevalence of isolated systolic hypertension (ISH) in aging Western societies.
- Individuals with ISH face a significantly elevated risk of stroke and ischemic heart disease.
Purpose of the Study:
- To assess the clinical significance of systolic blood pressure (BP) in hypertension.
- To investigate the prevalence and impact of isolated systolic hypertension (ISH) in aging populations.
- To evaluate the efficacy of antihypertensive therapy for ISH through the Systolic Hypertension in the Elderly Program (SHEP) trial.
Main Methods:
- Review of historical clinical perspectives on diastolic versus systolic BP in hypertension.
- Analysis of observational studies linking systolic BP to cerebrovascular disease and mortality.
- Initiation of the large-scale, multicenter Systolic Hypertension in the Elderly Program (SHEP) clinical trial.
Main Results:
- Observational data indicate systolic BP is a stronger predictor of cerebrovascular events than diastolic BP in aging populations.
- Isolated systolic hypertension (ISH) is associated with a 2- to 5-fold increased risk of stroke and ischemic heart disease.
- The SHEP trial is ongoing, with results anticipated to provide crucial data on ISH treatment efficacy.
Conclusions:
- Systolic blood pressure (BP) is a critical factor in hypertensive morbidity and mortality, particularly in the elderly.
- Isolated systolic hypertension (ISH) represents a significant and growing clinical challenge.
- The SHEP trial is expected to provide definitive evidence on the benefits of treating ISH, guiding future therapeutic strategies.
Abstract:
Historically diastolic blood pressure (BP) rather than systolic BP has been regarded clinically as the more important component related to subsequent hypertensive morbidity and mortality, and treatment has thus been directed towards lowering the diastolic BP. Observational studies across many different populations have related cerebrovascular disease and death more to the systolic BP, which appears selectively to increase as the population ages. Isolated systolic hypertension (ISH), therefore, may be more prevalent as westernized societies become older. Those affected with ISH suffer a two- to fivefold increase in rates of stroke and ischemic heart disease compared to normotensives. Currently no clinical trials data exist for ISH showing the efficacy of antihypertensive therapy upon final morbidity and mortality, but a large-scale multicenter clinical trial, the Systolic Hypertension in the Elderly Program (SHEP), is currently underway in the United States. Results are expected in the early 1990s. If the results of this trial confirm the efficacy of treating ISH, the therapeutic challenge of ISH will be to selectively decrease systolic BP without undue side effects.