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[Isolated systolic arterial hypertension in the elderly]
B Ivanović-Krstić1, D Cvetković-Matić, Dj Nikcević
1Institute Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade.
Insights
Treatment of isolated systolic hypertension in the elderly with diuretics or beta blockers significantly reduces stroke and cardiovascular events. Further research is needed on newer agents for long-term outcomes.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Hypertension Research
Context:
- Isolated systolic hypertension (ISH) is prevalent in the elderly, posing significant risks for stroke and cardiovascular disease.
- Arterial stiffening, a hallmark of aging, is the primary driver of elevated systolic pressure in older adults.
- ISH diagnosis can be challenging due to blood pressure variability, often requiring ambulatory monitoring.
Purpose:
- To evaluate the efficacy of antihypertensive treatments in mitigating cardiovascular and cerebrovascular complications associated with ISH.
- To review recent clinical trials investigating the impact of pharmacological interventions on ISH outcomes in the elderly population.
Summary:
- Recent trials (STOP-Hypertension, SHEP, MRC) demonstrate that diuretics and/or beta blockers effectively reduce stroke and major cardiovascular events in elderly patients with ISH.
- Combination therapy with diuretics and beta blockers showed significant benefits.
- Newer agents like calcium channel blockers and ACE inhibitors lower systolic blood pressure but require further study for long-term effects.
Impact:
- Treatment of ISH with established agents like diuretics and beta blockers offers a clear benefit in reducing morbidity and mortality.
- Evidence supports the use of these medications for preventing serious cardiovascular and cerebrovascular events in older adults.
- Further investigation is warranted to establish the long-term safety and efficacy of novel antihypertensive drugs for ISH.
Abstract:
Isolated systolic hypertension is a common disorder in the elderly carrying a high risk of stroke and cardiovascular disease. Isolated systolic hypertension is usually defined as a systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 95 mmHg. The arterial stiffening is the principal cause of increasing systolic pressure in advanced age. It is due to degeneration of the arterial wall and is associated with progressive arterial dilatation. Hypertension in elderly patients is also characterized by increase of peripheral vascular resistance. Due to the wide variability of blood pressure usually seen in old persons, the isolated systolic hypertension is not easy to recognize and final diagnosis requires a long period of observation. The ambulatory blood pressure monitoring proved to be helpful in distinguishing patients with true isolated systolic hypertension from subjects with exaggerated alarm reaction to the pressure measurement. Although the increased risk of cardiovascular and cerebrovascular mortality is well established for isolated systolic hypertension, there has been much debate whether available antihypertensive treatment can prevent or delay cardiovascular and cerebrovascular complications in this condition. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP and MRC trials. All studies have demonstrated that the treatment of isolated systolic hypertension with diuretics or/and beta blockers (frequently used in combination) resulted in a significant reduction in the incidence of stroke and major cardiovascular events. New antihypertensive agents such as calcium channel blockers and angiotensin-converting enzyme inhibitors have also been shown to effectively lower systolic blood pressure in the elderly but the effects on long-term morbidity and mortality are still unknown.