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Treatment of isolated systolic hypertension

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Abstract

Isolated systolic hypertension (ISH) is the dominant form of hypertension in the elderly. It is associated with increased arterial pulse pressure, to which an early-returning and magnified pulse-wave reflection makes an important contribution. Treatment of ISH with diuretics, calcium channel blockers (CCBs), and angiotensin II inhibitors is effective in reducing systolic blood pressure, preventing cardiovascular morbid events, and lowering mortality; these agents may have to be used in combination to achieve the systolic blood pressure goal of < 140 mm Hg. Treatment with β-blockers appears to be less effective. The relative efficacy of various classes of antihypertensive drugs for lowering pulse pressure and systolic blood pressure is determined in part by their differing abilities to reduce pulse-wave reflection. In patients with ISH that is refractory to dual or triple therapy, measurement of the reflected wave by applanation tonometry may be useful in determining which additional antihypertensive agent to use.

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References and Recommended Reading

  1. Franklin SS, Jacobs MJ, Wong ND, et al.: Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives. Analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension 2001, 37:869–874.

    PubMed  CAS  Google Scholar 

  2. Amery A, Birkenhager W, Brixko P, et al.: Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet 1985, 1:1349–1354.

    Article  PubMed  CAS  Google Scholar 

  3. SHEP Cooperative Research Group:Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991, 265:3255–3264.

    Article  Google Scholar 

  4. Dahlof B, Lindholm LH, Hansson L, et al.: Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (Stop-Hypertension). Lancet 1991, 338:1281–1285.

    Article  PubMed  CAS  Google Scholar 

  5. Staessen JA, Thijs L, Fagard R, et al.: Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension: Systolic Hypertension in Europe Trial Investigators. JAMA 1999, 282:539–546.

    Article  PubMed  CAS  Google Scholar 

  6. Hyman DJ, Pavlik VN: Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine. Arch Intern Med 2001, 160:2281–2286.

    Article  Google Scholar 

  7. Staessen JA, Gasowski J, Wang JG, et al.: Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet 2000, 355:865–872.

    Article  PubMed  CAS  Google Scholar 

  8. O’Rourke MF, Kelly RP: Wave reflection in the systemic circulation and its implications in ventricular function. J Hypertens 1993, 11:327–337.

    Article  PubMed  CAS  Google Scholar 

  9. Schiffrin EL: Vascular stiffening and arterial compliance. Implications for systolic blood pressure. Am J Hypertens 2004, 17:39S-48S. This review describes methods for the measurement of arterial stiffness, and examines the relationship between stiffness and other cardiovascular risk factors.

    Article  PubMed  CAS  Google Scholar 

  10. Wilkinson IB, Hall IR, MacCallum H, et al.: Pulse-wave analysis. Clinical evaluation of a non-invasive, widely applicable method for assessing endothelial function. Arterioscler Thromb Vasc Biol 2002, 22:147–152.

    Article  PubMed  CAS  Google Scholar 

  11. Cohn JN:. Vascular wall function as a risk marker for cardiovascular disease. J Hypertens 1999, 17(Suppl 5):S41-S44.

    CAS  Google Scholar 

  12. Stokes GS: Nitrates as adjunct hypertensive treatment. Curr Hypertens Rep 2006, 8:60–68.

    Article  PubMed  CAS  Google Scholar 

  13. Stokes GS, Barin ES, Gilfillan KL: Effects of isosorbide mononitrate and AII inhibition on pulse wave reflection in hypertension. Hypertension 2003, 41:297–301. Shows that isosorbide mononitrate is more effective than Ang II inhibitors in reducing pulse-wave reflection, and examines implications this has for understanding the mechanisms that cause the reflected wave.

    Article  PubMed  CAS  Google Scholar 

  14. Weinberger MH, Miller JZ, Luft FC, et al.: Definitions and characteristics of sodium sensitivity and blood pressure resistance. Hypertension 1986, 8:127–134.

    Google Scholar 

  15. Bagrov AY, Lakatta EG: The dietary sodium-blood pressure plot “stiffens.” Hypertension 2004, 44:22–24.

    Article  PubMed  CAS  Google Scholar 

  16. Pickering TG: Why don’t we use nitrates to treat older hypertensive patients? J Clin Hypertens 2005, 7:685–690.

    CAS  Google Scholar 

  17. Chen C-H, Ting C-T, Lin S-J, et al.: Different effects of fosinopril and atenolol on wave reflections in hypertensive patients. Hypertension 1995, 25:1034–1041.

    PubMed  CAS  Google Scholar 

  18. Morgan TO, Lauri J, Bertram D, Anderson A: Effect of different antihypertensive drug classes on central aortic pressure. Am J Hypertens 2004, 17:118–123. The relationship between central aortic blood pressure, a key determinant of cardiac workload, and brachial artery blood pressure was found to vary between drugs of the four major antihypertensive drug classes.

    Article  PubMed  CAS  Google Scholar 

  19. Townsend MS, Fulgoni VL III, Stern JS, et al.: Low mineral intake is associated with high systolic blood pressure in the Third and Fourth National Health and Nutrition Examination Surveys. Could we all be right? Am J Hypertens 2005, 18:261–269.

    Article  PubMed  Google Scholar 

  20. He FJ, Markandu ND, MacGregor GA: Modest salt reduction lowers blood pressure in isolated systolic hypertension and combined hypertension. Hypertension 2005, 46:66–70.

    Article  PubMed  CAS  Google Scholar 

  21. Gates PE, Tanaka H, Hiatt WR, Seals DR: Dietary sodium restriction rapidly improves large elastic artery compliance in older adults with systolic hypertension. Hypertension 2004, 44:35–41. This study investigates the effect of low-sodium diet on stage I hypertensive subjects, and shows that improvements in central compliance appear to be key in the lowering of systolic blood pressure by sodium restriction.

    Article  PubMed  CAS  Google Scholar 

  22. Brennan P, Pescatello LS, Bohannon RW, et al.: Time spent moving is related to systolic blood pressure among older women. Prev Cardiol 2005, 8:160–164.

    Article  PubMed  Google Scholar 

  23. Ferrier KE, Waddell TK, Gatzka CD, et al.: Aerobic exercise training does not modify large-artery compliance in isolated systolic hypertension. Hypertension 2001, 38:222–226.

    PubMed  CAS  Google Scholar 

  24. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 2002, 288:2981–2997.

    Article  Google Scholar 

  25. London G, Schmieder R, Calvo C, Asmar R: Indapamide SR versus candesartan and amlodipine in Hypertension: the X-CELLENT Study. Am J Hypertens 2006, 19:113–121.

    Article  PubMed  CAS  Google Scholar 

  26. Kostis JB, Wilson AC, Freudenberger RS, et al.: Longterm effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes. SHEP Collaborative Research Group. Am J Cardiol 2005, 95:29–35.

    Article  PubMed  CAS  Google Scholar 

  27. Chen GJ, Ferrucci L, Moran WP, Pahor M: A cost-minimization analysis of diuretic-based antihypertensive therapy reducing cardiovascular events in older adults with isolated systolic hypertension. Cost Eff Resour Alloc 2005, 3:2.

    Article  PubMed  Google Scholar 

  28. Xie F, Petitti DB, Handler J: Changes in the continuation of antihypertensive drug use after ALLHAT. J Clin Invest 2005, 7:649–653.

    CAS  Google Scholar 

  29. Black HR: The paradigm has shifted to systolic blood pressure. J Hum Hypertens 2004 18(Suppl 2):S3-S5.

    Article  PubMed  Google Scholar 

  30. Izzo JL, Levy D, Black HR: Importance of systolic blood pressure in older Americans. Hypertension 2000, 35:1021–1024. In regard to its acceptance of the blood pressure management goals of JNC VI for the elderly, the statement represents a milestone in the treatment of ISH.

    PubMed  Google Scholar 

  31. Hansson L, Lindholm LH, Ekbom T, et al.: for the STOP-Hypertension-2 Study Group: Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999, 354:1751–1756.

    Article  PubMed  CAS  Google Scholar 

  32. Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensinconverting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153.

    Article  PubMed  CAS  Google Scholar 

  33. Turnbull F; Blood Pressure Treatment Trialists’ Collaboration: Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectivelydesigned overviews of randomized trials. Lancet 2003, 362:1527–1535.

    Article  PubMed  CAS  Google Scholar 

  34. Kjeldsen SE, Lyle PA, Kizer JR, et al.: The effects of losartan compared to atenolol on stroke in patients with isolated systolic hypertension and left ventricular hypertrophy. The LIFE study. J Clin Hypertens 2005, 7:152–158.

    Google Scholar 

  35. Dahlof B, Sever PS, Poulter NR, et al.: Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005, 366:895–906. This very large trial in patients 40 to 79 years of age showed that a CCB plus ACE inhibitor combination was more effective than a β-blocker plus diuretic combination in reducing cardiovascular morbidity.

    Article  PubMed  Google Scholar 

  36. Messerli FH, Grossman E, Goldbourt U: Are beta-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review. JAMA 1998, 278:1903–1907.

    Article  Google Scholar 

  37. Carlberg B, Samuelsson O, Lindholm LH: Atenolol in hypertension: Is it a wise choice? Lancet 2004, 364:1684–1689.

    Article  PubMed  CAS  Google Scholar 

  38. Lindholm LH, Carlberg B, Samuelsson O: Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005, 366:1545–1553. This meta-analysis of controlled treatment trials in hypertension concludes that the relative risk for stroke was 16% higher for β-blockers than for other antihypertensive drugs.

    Article  PubMed  CAS  Google Scholar 

  39. Beevers G: The end of beta-blockers for uncomplicated hypertension? Lancet 2005, 366:1510–1512.

    Article  PubMed  Google Scholar 

  40. Williams B, Lacy PS, Thom SM, et al.: The CAFE Investigators, for the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Investigators, CAFE Steering Committee and Writing Committee. Differential impact of blood pressure -lowering drugs on central aortic pressure and clinical outcomes: principal results of the conduit artery function evaluation (CAFE) study. Circulation 2006, 113:1213–1225. Different effects on central aortic blood pressure despite similar effects on brachial blood pressure may explain the different clinical outcomes between treatment arms of the ASCOT Trial 34.

    Article  PubMed  CAS  Google Scholar 

  41. Stokes GS, Bune AJ, Huon N, Barin ES: Long-term effectiveness of extended-release nitrate for the treatment of systolic hypertension. Hypertension 2005, 45:380–384.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Gordon S. Stokes MBBS, MD, FRACP.

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Stokes, G.S. Treatment of isolated systolic hypertension. Current Science Inc 8, 377–383 (2006). https://doi.org/10.1007/s11906-006-0081-0

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