[Isolated systolic hypertension: epidemiologic aspects, prevention, and risk]

Epidemiological studies have shown since long that around 20% of elderly people suffer from isolated systolic hypertension. More recently it was calculated that this condition implies a 3 fold increase in the incidence of cerebrovascular accidents and a 2.2 fold increase in the incidence of myocardial infarction. This is why more attention is now dedicated to this condition by both clinicians and research workers, especially since the recent demonstration that its treatment may lead to a reduction in morbidity and mortality from cerebrovascular causes. Unfortunately it was also shown that antihypertensive drugs are more likely to be not so well tolerated in elderly hypertensives as in adults and often worsen the quality of life. For this reason a careful selection of the patients to be submitted to treatment and a close evaluation of the hypotensive response once therapy has been started seem in order. To this end 24-hour blood pressure monitoring would seem useful as it gives more reliable information on the usual blood pressure of an individual and furthermore it allows the detection of orthostatic hypotension and of possible excessive blood pressure falls at night which are frequent causes of untoward side effects on one hand and of ischemic events on the other.