Overview on atherosclerotic systolic hypertension

Hypertension in older atherosclerotic patients is characterised by a disproportionate elevation of systolic and pulse pressure contrasting with a subnormal diastolic level. Increased systolic pressure is strongly related to the excess of cerebrovascular complications and congestive heart failure observed in these patients. The physiopathological pattern is marked by a strong reduction in compliance of large arteries directly responsible for the predominant high systolic pressure because of the impairment of the buffering function of the arteries on the cardiac pulse wave. Clinical management is directed to the elevation of athero-arteriosclerotic changes of large arteries by means of appropriate non-invasive ultrasonic techniques and specific lowering in systolic pressure. Antihypertensive treatment must specifically decrease systolic pressure without superimposing adverse effects on the generalized and focalized atherosclerotic process. In this respect, new pharmacological agents capable of direct actions on large arteries might be suitable.