Isolated systolic hypertension
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Definition and Prevalence of Isolated Systolic Hypertension
Isolated systolic hypertension (ISH) is defined as a systolic blood pressure (SBP) greater than 140 mmHg with a diastolic blood pressure (DBP) less than 90 mmHg 12. ISH is the most common form of hypertension in people over 50 years old, and its prevalence increases with age. In those over 80, more than 90% of untreated hypertension cases are ISH . Among people over 60, about half are affected by ISH 23. ISH is also increasingly recognized in young and middle-aged adults, though it is more common in the elderly 5610.
Cardiovascular Risks Associated with Isolated Systolic Hypertension
ISH is not a benign condition; it is linked to a significant increase in cardiovascular risk, including higher rates of stroke, coronary heart disease, and overall cardiovascular mortality 2345610. Studies show that both young and older adults with ISH have a higher risk of cardiovascular disease (CVD) events and death compared to those with normal blood pressure 5610. The risk associated with ISH in young adults is similar to that of isolated diastolic hypertension and lower than that of combined systolic-diastolic hypertension 5610.
Pathophysiology and Development of ISH
The development of ISH is mainly attributed to age-related changes in the arteries, such as stiffening, which leads to increased systolic pressure while diastolic pressure remains normal or low 34. Some individuals develop ISH as a progression from earlier diastolic hypertension, but most cases occur without a prior stage of elevated diastolic pressure . Modifiable risk factors, such as lifestyle and other health conditions, also contribute to the development of ISH .
Diagnosis and Measurement Challenges
ISH is typically diagnosed using upper-arm cuff blood pressure measurements. However, studies have shown that cuff measurements can misclassify ISH status in a significant number of older adults when compared to invasive aortic blood pressure measurements. This highlights the need for improved accuracy in blood pressure measurement techniques, especially in the elderly .
Treatment and Management of Isolated Systolic Hypertension
Treating ISH in older adults has been shown to reduce the risk of cardiovascular events. Large clinical trials, such as the Systolic Hypertension in the Elderly Program (SHEP), Systolic Hypertension in Europe (Syst-Eur), and Systolic Hypertension in China (Syst-China), have demonstrated the benefits of antihypertensive drug treatment in reducing adverse outcomes in patients with ISH 378. Meta-analyses confirm that treating ISH in patients with systolic blood pressure of 160 mmHg or higher is justified and effective . However, ISH remains underdiagnosed and undertreated, partly due to historical focus on diastolic pressure and concerns about lowering systolic pressure in the elderly .
Conclusion
Isolated systolic hypertension is a common and serious health issue, especially in older adults, but also present in younger populations. It is associated with a significant increase in cardiovascular risk and requires accurate diagnosis and effective management. Treating ISH can reduce the risk of heart attack, stroke, and death, making it a critical target for public health interventions 2356710.
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