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Systolic hypertension in the elderly. Relationship with cardiovascular disease
1Department of Heart and Hypertension, Cleveland Clinic Foundation, OH 44195-5069.
Insights
Elderly patients with isolated systolic hypertension should first try nonpharmacologic therapy. If blood pressure remains high, cautious, low-dose medication may be beneficial and well-tolerated.
Area of Science:
- Cardiology
- Geriatrics
- Hypertension Management
Background:
- Elevated systolic blood pressure increases risks of stroke and myocardial infarction.
- Antihypertensive therapy benefits elderly patients with diastolic hypertension.
- Limited trial data exists for elderly patients with isolated systolic hypertension.
Purpose of the Study:
- To outline a treatment approach for elderly patients with isolated systolic hypertension.
- To emphasize initial nonpharmacologic interventions.
- To guide cautious pharmacologic management if needed.
Main Methods:
- Initial six-month trial of nonpharmacologic therapy.
- Gradual dose titration of antihypertensive medications if systolic pressure remains elevated.
- Low-dose initiation of drug treatment.
Main Results:
- Nonpharmacologic therapy is recommended as the initial treatment.
- Cautious, slow-titrated drug treatment can be beneficial.
- This approach may improve tolerability and outcomes.
Conclusions:
- Nonpharmacologic therapy should precede drug treatment for isolated systolic hypertension in the elderly.
- Careful pharmacologic management, starting with low doses, is a reasonable next step.
- A well-tolerated and beneficial treatment plan is achievable.
Abstract:
The risk of stroke and myocardial infarction is increased in patients with elevated systolic blood pressure. Although treatment trials have demonstrated the benefit of antihypertensive therapy in elderly patients with diastolic hypertension, the only trial conducted in elderly patients with isolated systolic hypertension is currently in progress. A six-month trial of nonpharmacologic therapy should generally be the initial treatment in patients with isolated systolic hypertension. Then, if systolic pressure remains elevated, a cautious trial of drug treatment is reasonable. The drug used should be started in a low dose, and the dose should be titrated slowly. With this approach, antihypertensive treatment of elderly patients with isolated systolic hypertension may be well tolerated and ultimately beneficial.