Isolated Systolic Hypertension — Independent Risk Factor Cardiovascular Complications

Abstract

Isolated systolic hypertension (ISH) is a distinct pathophysiological entity in which the rise in systolic blood pressure is mainly due to a decreased elasticity of the large arteries. As it was shown in Framingham study systolic blood pressure is a better predictor of cardiovascular morbidity and mortality than diastolic blood pressure. ISH doubles all-cause mortality, and almost triples cardiovascular mortality. The prevalence of ISH rises with age since the arterial wall gets stiffer with increasing age. The principal cause of the stiffening of the arteries is diffuse fibroelastic intima thickening, which is physiological aging phenomenon and is accelerated by increased blood pressure. Stiffening of the arteries induces an increase systolic pressure, left ventricular hypertrophy and alteration in coronary flow. The pooled results of the outcome trials in older patients with ISH prove that active treatment reduced total mortality, cardiovascular mortality, all cardiovascular complications, stroke and coronary events. Treatment prevented stroke more effectively than coronary events.