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Are systolic/diastolic and isolated systolic hypertension risk factors for the elderly?
1Division of Medicine, Cleveland Clinic Foundation, OH.
Insights
Elevated blood pressure, both diastolic and isolated systolic hypertension (ISH), increases cardiovascular risk in all age groups. Treating hypertension in the elderly is crucial for reducing morbidity and mortality.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Diastolic hypertension elevates cardiovascular risk similarly in younger and elderly patients.
- Isolated systolic hypertension (ISH) is a significant, often underestimated, cardiovascular risk factor in the elderly.
- ISH is not merely a marker of arteriosclerosis but a distinct clinical entity.
Purpose of the Study:
- To highlight the cardiovascular risks associated with both diastolic and isolated systolic hypertension in the elderly.
- To emphasize the importance of treating hypertension in older adults.
- To discuss the current understanding and ongoing research regarding ISH management.
Main Methods:
- Review of data from large prospective trials on hypertension treatment.
- Analysis of theoretical and clinical data refuting the arteriosclerosis marker theory for ISH.
- Mention of the ongoing Systolic Hypertension in the Elderly Program (SHEP).
Main Results:
- Treating diastolic hypertension demonstrably reduces cardiovascular risk.
- ISH may be a greater determinant of cardiovascular risk in the elderly than diastolic hypertension.
- Prospective data on ISH treatment benefits are pending.
Conclusions:
- Both diastolic and isolated systolic hypertension are significant cardiovascular risks in the elderly.
- ISH requires dedicated clinical attention and is not a benign aging phenomenon.
- Ongoing trials like SHEP are expected to provide crucial guidelines for managing ISH in older adults.
Abstract:
Diastolic elevation of blood pressure increases the relative risk of cardiovascular morbidity and mortality as much for the elderly patient as it does for the younger patient, and data from large prospective trials show that treating it will reduce the risk. Isolated systolic hypertension (ISH), long mistakenly regarded as a natural phenomenon of aging, may be an even greater determinant of cardiovascular risk in elderly patients than diastolic hypertension. Theoretical and clinical data refute the theory that ISH is merely a marker for medial arteriosclerosis. Although no prospective data regarding the benefit of treating ISH are yet available, the Systolic Hypertension in the Elderly Program, currently under way, should be able to provide clinicians with guidelines for treating this condition.