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Isolated systolic hypertension in the elderly: new insights
1Department of 1st Clinical Medicine, University of Padua, Italy.
Insights
Isolated Systolic Hypertension (ISH) significantly increases mortality risk. Treatment effectively reduces stroke and cardiovascular events in elderly patients with ISH.
Area of Science:
- Cardiology
- Geriatrics
- Hypertension Research
Background:
- Isolated Systolic Hypertension (ISH) presents a significant mortality risk, particularly from myocardial infarction, stroke, and cardiac failure.
- The pathophysiology involves decreased arterial compliance and altered wave reflection timing, common in the elderly.
- Diagnosing ISH can be challenging due to blood pressure variability in older adults, often requiring extended monitoring.
Purpose of the Study:
- To evaluate the effectiveness of antihypertensive treatment in preventing cardiovascular complications in patients with Isolated Systolic Hypertension.
- To determine if interventions can mitigate the excess cardiovascular mortality associated with ISH.
Main Methods:
- Utilized ambulatory blood pressure monitoring to accurately diagnose true ISH versus exaggerated alarm reactions.
- Conducted the SHEP (Systolic Hypertension in the Elderly Program) study to assess treatment outcomes.
- Employed low-dose chlortalidone, alone or in combination with atenolol or reserpine, as therapeutic interventions.
Main Results:
- The SHEP study demonstrated significant reductions in adverse cardiovascular outcomes.
- Stroke incidence was reduced by 35% in the treated group.
- Overall cardiovascular events decreased by 32% with the antihypertensive regimen.
Conclusions:
- Antihypertensive treatment is effective in managing Isolated Systolic Hypertension in the elderly.
- Therapeutic interventions significantly reduce the risk of stroke and other major cardiovascular events in ISH patients.
- The findings support the use of low-dose chlortalidone-based regimens for cardiovascular risk reduction in ISH.
Abstract:
Isolated Systolic Hypertension (ISH) is associated with a several-fold excess risk of mortality from myocardial infarction, stroke and cardiac failure. Decreased compliance of large arteries and altered timing of reflected waves from peripheral vessels account for the selective increase in systolic pressure present in the elderly. Due to the wide variability of blood pressure frequently seen in old subjects, ISH is not easy to recognize and diagnosis requires a long period of observation. Ambulatory blood pressure monitoring proved helpful in distinguishing between patients with true ISH and subjects with exaggerated alarm reaction to the pressure measurement. Although the increased risk of cardiovascular mortality is well established for ISH, there has been much debate over whether available antihypertensive treatment can prevent or delay cardiovascular complications in ISH. The results of the SHEP study, recently published, demonstrate positive effects of treatment in ISH, as stroke (-35%) and all cardiovascular events (-32%) were significantly reduced by low-dose chlortalidone alone or associated to atenolol or reserpine.