Reasons for high systolic blood pressure
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Reasons for High Systolic Blood Pressure
Age-Related Arterial Stiffening
One of the primary reasons for elevated systolic blood pressure (SBP) is age-related arterial stiffening. As individuals age, their large arteries become less elastic, leading to increased systolic pressure. This stiffening process is particularly significant in individuals over 50-60 years old and is a major contributor to systolic hypertension in older adults 238.
Vascular Structure and Function
The structure and function of the vasculature play crucial roles in blood pressure regulation. Large conduit arteries and the microcirculation are involved in the mechanisms that elevate blood pressure. In older individuals, arterial stiffening leads to increased systolic BP, which penetrates deeper into the distal vasculature, causing microcirculatory injury and endothelial dysfunction. This results in target organ damage in the heart, brain, and kidneys .
Genetic Predisposition and Lifestyle Factors
Genetic predisposition is another significant factor contributing to high systolic blood pressure. Individuals with a genetic risk for hypertension are more likely to develop elevated BP, especially when combined with adverse lifestyle factors such as high salt intake, overweight, and excessive alcohol consumption. These lifestyle factors can enhance sympathetic activity and vasoconstriction, leading to persistent high blood pressure .
Inflammation and Endothelial Dysfunction
Inflammation and endothelial dysfunction are also critical in the development of high systolic blood pressure. Inflammatory processes, including those involving perivascular fat, contribute to the remodeling of microvessels, which increases resistance to blood flow and raises blood pressure. This remodeling process is exacerbated by factors such as salt intake and gut microbiome dysbiosis .
Poor Blood Pressure Control and Awareness
Despite the availability of numerous antihypertensive medications, blood pressure control remains inadequate in many populations. This inadequacy is often due to low awareness of hypertension among healthcare professionals and patients, under-treatment, and tolerability issues with antihypertensive drugs. Additionally, current treatments often do not address the underlying vascular pathology of systolic hypertension, necessitating the development of novel drugs that target arterial stiffening .
Global Trends and Population Growth
Global trends indicate that the prevalence of raised blood pressure has shifted from high-income countries to low-income countries, particularly in South Asia and sub-Saharan Africa. This shift is attributed to population growth and aging, which have increased the number of adults with raised blood pressure. The global increase in systolic blood pressure is a net effect of these demographic changes combined with declining age-specific prevalence in some regions .
Conclusion
High systolic blood pressure is influenced by a combination of age-related arterial stiffening, genetic predisposition, lifestyle factors, inflammation, and inadequate blood pressure control. Addressing these factors through lifestyle modifications, improved awareness, and novel therapeutic approaches is essential for managing and reducing the risks associated with elevated systolic blood pressure.
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