Understanding and Managing Isolated Systolic Hypertension in the Elderly.
In summary, ISHT in the elderly is a result of the interaction of increased systemic vascular resistance and of progressive arterial stiffening. The early return of reflected pulse wave may add to peak SBP in the ascending aorta and central arteries, thereby increasing LV systolic stress (afterload). Antihypertensive therapy has been shown to be effective in the prevention of strokes associated with ISHT. The reduction in the incidence of fatal and non fatal MI by active treatment may be limited by excessive lowering of DBP, resulting in inadequate myocardial perfusion in some patients (J-curve). The ideal drug for the treatment of ISHT should reduce systemic vascular resistance, increase large artery compliance, and delay the return of reflected wave in central arteries. Diuretics effectively lower SBP in the elderly with ISHT. Long-acting nitrates lower SBP selectively and have a favorable effect on LV systolic stress (afterload). Baroreceptor dysfunction due to increased arterial stiffness increases the risk of orthostatic and postprandial hypotension in the elderly during antihypertensive therapy.
Simon
Geza
G
Hypertension Clinic and Cardiology Section, Department of Medicine, VA Medical Center and University of Minnesota Medical School, Minneapolis, MN.
Chesler
Elliot
E