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Is the Cardiovascular Risk Increased in Patients with Isolated Systolic Hypertension and Anemia?

Koracevic Goran^1,2, Micic Sladjana³, Stojanovic Milovan^2,4

¹Department for Cardiovascular Diseases, University Clinical Center Nis, Nis, Serbia.

Current Vascular Pharmacology

|May 15, 2026

Insights

Isolated systolic hypertension (ISH) and anemia are highly prevalent conditions, particularly in the elderly. This study highlights the increased cardiovascular risk in patients with both ISH and anemia, a link not currently recognized in hypertension guidelines.

Area of Science:

Cardiology
Geriatrics
Internal Medicine

Background:

Isolated systolic hypertension (ISH) is a highly prevalent condition, especially among the elderly.
Anemia is also a common non-communicable disease with significant public health implications.
The co-existence and implications of anemia in patients with ISH remain under-recognized.

Purpose of the Study:

To investigate the relationship between anemia and diastolic blood pressure (dBP).
To determine the association between ISH and anemia.
To assess the cardiovascular risk in ISH patients with co-existing anemia and its recognition in hypertension guidelines.

Main Methods:

Literature search conducted across multiple databases (SCOPUS, Springer Verlag, Elsevier, PubMed, Google Scholar).
Search strategy included terms for 'isolated systolic hypertension' and 'anemia', excluding guidelines.
A separate search focused on arterial hypertension (HTN) guidelines to identify mentions of ISH, anemia, and their relationship.

Main Results:

Anemia is frequently associated with decreased diastolic blood pressure (dBP) due to various pathophysiological mechanisms.
Both ISH and anemia are independently associated with low dBP.
Anemia and ISH are significant public health concerns due to their high prevalence, particularly in the elderly population.

Conclusions:

Anemia in the context of ISH represents a significant, clinically relevant, and previously underappreciated problem.
Patients with ISH and concurrent anemia face an elevated cardiovascular risk.
Current hypertension (HTN) guidelines do not adequately recognize the significance of anemia in ISH, partly due to conciseness requirements.

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Abstract

Introduction:

Isolated systolic hypertension (ISH) is important because of its very high prevalence. Anemia is also a highly prevalent non-communicable disease. The paper aims to answer the study questions: 1) Is there a relation between anemia and dBP?; 2) Is there a link between ISH and anemia?; 3) Are ISH and anemia important due to their prevalence?; 4) Is the cardiovascular risk increased in ISH patients with anemia?5) Is this recognized in HTN guidelines?

Methods:

Search 1 was done for 'isolated systolic hypertension' and 'anemia' in papers (excluding guidelines). Search 2 was performed for arterial hypertension (HTN) guidelines, to see if there is a part about 'isolated systolic hypertension' and about 'anemia', as well as about their relationship. We performed a SCOPUS, Springer Verlag, Elsevier, PubMed, and Google Scholar search.

Results:

Diastolic blood pressure is often decreased in anemia, due to abundant pathophysiological mechanisms. Moreover, dBP is often low in both ISH and anemia. Third, anemia and ISH are important due to their high prevalence, especially in the elderly.

Discussion:

The main result of the study is the identification of the important, clinically relevant, previously undefined problem: anemia in ISH. Cardiovascular risk is increased in ISH patients with anemia. The significance of anemia in ISH is not recognized in HTA guidelines, partially because they need to be concise.

Conclusion:

The overlooked problem of anemia in ISH needs recognition both in clinical practice, to avoid overzealous dBP reduct.

Keywords:

Anemia arterial hypertension blood pressure diastolic blood pressure guidelines isolated systolic hypertension

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