Prevalence of isolated systolic hypertension (ISH) in Slovene hypertensive patients: insights from the “Quality of Healthcare in Slovenia” project

Summary

Objectives

The aim of the present study was mainly to evaluate age- and gender-dependent isolated systolic hypertension (ISH) prevalence before and during antihypertensive treatment, and to evaluate pulse pressure (PP) distributions during antihypertensive treatment in almost 20,000 Slovene hypertensive patients.

Methods

The study was conducted as part of the “Quality of Healthcare in Slovenia” project, in agreement with the National Medical Ethics Committee of the Republic of Slovenia. Appropriate statistical analyses and evaluations were performed.

Results

The prevalence of ISH before the treatment was 19.6 % (17.0 % for men and 21.4 % for women) and it was significantly (p < 0.001) higher during the treatment (29.6 %; 26.4 % for men and 31.9 % for women). The mean PP before the treatment for the whole study patient sample was (71.2 ± 16.9) mmHg and was significantly (p < 0.001) reduced during the treatment to (57.4 ± 12.5) mmHg.

Conclusion

With regard to high ISH in treated Slovene hypertensive patients, quality of ISH control may not be optimal and should be improved. On the other hand, the adequate arterial hypertension (AH) control (systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg) was achieved in 55.6 % of patients. Our observations may have useful therapeutic implications in the management of AH, particularly ISH in the elderly.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1

    Chobanian AV. Clinical practice. Isolated systolic hypertension in the elderly. N Engl J Med. 2007;357(8):789–96.

    CAS  Article  PubMed  Google Scholar 

  2. 2

    Mancia G, Fagard R, Narkiewicz K, et al. ESH/ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–219.

    Article  PubMed  Google Scholar 

  3. 3

    Accetto R, et al. Slovenske smernice za zdravljenje arterijske hipertenzije 2013 (2013 Slovene guidelines for the management of arterial hypertension). In: Zbornik XXII. strokovnega sestanka Sekcije za arterijsko hipertenzijo; 2013. Ljubljana, Slovenija: Ljubljana: Slovensko zdravniško društvo. Sekcija za arterijsko hipertenzijo; 2013.

  4. 4

    Eurostat’s Population Projections for Slovenia by sex, EUROPOP2008 and cohesion regions 2008–2030, convergence scenario. Statistical Office of the Republic Slovenia [Internet]. 2009 [cited 2012 May 5]. Available from: http://www.stat.si/eng/novica_prikazi.aspx?id=2850.

  5. 5

    Glynn RJ, Chae CU, Guralnik JM, Hennekens CH. Pulse pressure and mortality in older people. Arch Intern Med. 2000;160(18):2765–72.

    CAS  Article  PubMed  Google Scholar 

  6. 6

    Sulbarán TA, Silva ER, Maestre G. Isolated systolic hypertension: a new challenge in medicine. J Hum Hypertens. 2002;16(Suppl1):S44–7.

    Article  PubMed  Google Scholar 

  7. 7

    Van Bortel LM, Struijker-Boudier HA, Safar ME. Pulse pressure, arterial stiffness, and drug treatment of hypertension. Hypertension. 2001;38(4):914–21.

    Article  PubMed  Google Scholar 

  8. 8

    Skurnick JH, Aladjem M, Aviv A. Sex differences in pulse pressure trends with age are cross-cultural. Hypertension. 2010;55(1):40–7.

    CAS  Article  PubMed  Google Scholar 

  9. 9

    Clara JG, De Macedo ME, Pego M. Prevalence of isolated systolic hypertension in the population over 55 years old. Results from a national study. Rev Port Cardiol. 2007;26(1):11–8.

    PubMed  Google Scholar 

  10. 10

    Pal M, Pajntar M, Leskošek B, Drinovec J, Ferk P. Pulse pressure in patients with arterial hypertension in Slovenia. Acta Medico-Biotehnica. 2011;4(2):11–7.

    Google Scholar 

  11. 11

    Pajntar M, Leskošek B. Quality of primary health care—blood pressure. In: Rotar-Pavlič D, editor. The international conference quality of primary health care, the perspective of patients; 2008 March 28–29; Ljubljana. Ljubljana: Zavod za razvoj družinske medicine, 2008; 38.

  12. 12

    Thijs L, Den Hond E, Nawrot T, Staessen JA. Prevalence, pathophysiology and treatment of isolated systolic hypertension in the elderly. Expert Rev Cardiovasc Ther. 2004;2(5):761–9.

    Article  PubMed  Google Scholar 

  13. 13

    Chobanian AV, Bakris GL, Black HR, et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.

    CAS  Article  PubMed  Google Scholar 

  14. 14

    Safar ME, Priollet P, Luizy F, et al. Peripheral arterial disease and isolated systolic hypertension: the ATTEST study. J Hum Hypertens. 2009;23(3):182–7.

    CAS  Article  PubMed  Google Scholar 

  15. 15

    Chaudhry SI, Krumholz HM, Foody JM. Systolic hypertension in older persons. JAMA. 2004;292(9):1074–80.

    CAS  Article  PubMed  Google Scholar 

  16. 16

    Farkas J, Zaletel-Kragelj L, Accetto R. Obravnava bolnikov z arterijsko hipertenzijo: dosedanje izkušnje in možnosti za izboljšanje. (Management of patients with arterial hypertension: current experience and improvement strategies). Zdrav Vest. 2008;77 (2):97–102.

    Google Scholar 

  17. 17

    Perry HM Jr, Davis BR, Price TR, et al. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the systolic hypertension in the elderly program (SHEP). JAMA. 2000;284(4):465–71.

    Article  PubMed  Google Scholar 

  18. 18

    Pal M, Ferk P. Drug interactions with angiotensin-converting enzyme inhibitors. Acta Med Bio. 2012;5(1):15–23.

    Google Scholar 

  19. 19

    Pal M, Leskošek LB, Ferk P. Poraba antihipertenzivnih zdravil in primerjava z Norveško. (Consumption of antihypertensives in Slovenia and comparison with Norway). Zdrav Vest. 2011;80(5):386–94.

    Google Scholar 

  20. 20

    Petek Ster M, Kersnik J. Knowledge and acceptance of hypertension guidelines in clinical practice: experience from Slovenia. Wien Klin Wochenschr. 2005;117(15–16):534–40.

    Article  PubMed  Google Scholar 

  21. 21

    Stokes GS. Management of hypertension in the elderly patient. Clin Interv Aging. 2009;4:379–89.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. 22

    Accetto R, Salobir B. Epidemiološka raziskava arterijske hipertenzije v Sloveniji-delno poročilo. Epidemiological research on arterial hypertension in Slovenia—In: Dolenc P. Zbornik XVIII. strokovnega sestanka Sekcije za arterijsko hipertenzijo. [Internet]. 2009 [cited 2011 Dec 23]; 9–19. Available from: http://www.hipertenzija.org/pdf/SAH_2009.pdf.

  23. 23

    Asmar R, Vol S, Brisac AM, Tichet J, Topouchian J. Reference values for clinic pulse pressure in a nonselected population. Am J Hypertens. 2001;14(5 Pt 1):415–8.

    CAS  Article  PubMed  Google Scholar 

  24. 24

    Safar ME, Vaisse B, Blacher J, Rudnichi A, Mourad JJ. Pulse pressure monitoring of open antihypertensive therapy. Am J Hypertens. 2004;17(12 Pt 1):1088–94.

    CAS  Article  PubMed  Google Scholar 

  25. 25

    Kannel WB, Wolf PA, McGee DL, Dawber TR, McNamara P, Castelli WP. Systolic blood pressure, arterial rigidity, and risk of stroke. The Framingham study. JAMA. 1981;245(12):1225–9.

    CAS  Article  PubMed  Google Scholar 

  26. 26

    Fariello R, Costa R, Crippa M, et al. Pattern and distribution of pulse pressure from young to elderly hypertensives. Am J Hypertens. 2001;14:P–66.

    Google Scholar 

Download references

Acknowledgements

The authors would sincerely like to thank all the family medicine physicians who were willing to participate in this study. We also thank Mr Alojz Tapajner from the Faculty of Medicine, University of Maribor for his help on performing statistical analyses as well as for his useful suggestions in interpreting statistical results.

Conflicts of interest in the manuscript, including financial, consultant, institutional, and other relationships

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Polonca Ferk.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pal, M., Ferk, P., Leskošek, B. et al. Prevalence of isolated systolic hypertension (ISH) in Slovene hypertensive patients: insights from the “Quality of Healthcare in Slovenia” project. Wien Klin Wochenschr 127, 247–254 (2015). https://doi.org/10.1007/s00508-015-0765-z

Download citation

Keywords

  • Isolated systolic hypertension
  • Pulse pressure
  • Arterial hypertension
  • Epidemiology
  • Quality of arterial hypertension treatment