Isolated systolic hypertension in the elderly subject

Interest in isolated systolic hypertension in the elderly has increased in the last few years. The definition of this disorder remains controversial: according to most authors, the systolic blood pressure has to be above 160 mm Hg and the diastolic under 90 mm Hg. The prevalence depends on number of visits, as well as on sex, age and race. The elderly is characterized by haemodynamic and neurohormonal features, which have to be pointed out: cardiac output and renal blood flow as well as hepatic blood flow are significantly lower than those of younger adults; great vessels compliance is diminished, baroreflex is impaired and cerebral autoregulation curve is shifted towards the right. From a prognostic point of view, systolic hypertension is now recognized as an independent risk factor for cardio-vascular morbidity and mortality. Recently, the SHEP study has demonstrated that the treatment of isolated systolic hypertension with diuretics alone or associated with beta-blockers resulted in a significant reduction in the incidence of stroke and major cardio-vascular events. The effectiveness of angiotensin-converting enzyme inhibitors and calcium antagonists is still under evaluation.