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Isolated Systolic Hypertension: In the Young and in the Elderly

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Disorders of Blood Pressure Regulation

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

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Abstract

Prevalence of the isolated increase in systolic blood pressure ≥140 mmHg with normal or low diastolic blood pressure ≤80 mmHg is defined as isolated systolic hypertension. Its prevalence increases with age up to ˃90% in patients aged ˃90 years. Isolated systolic hypertension is also found in the young and the clinical significance of it is still debated. For the therapy, those drugs should be used which have a licence for use in children: angiotensin-converting enzyme inhibitors, angiotensin AT-1 receptor antagonists, calcium channel blockers beta blockers and diuretics and their combinations. The young adults with isolated systolic hypertension had a much higher risk of dying from coronary heart disease or cardiovascular disease, then the normotensive individuals, and should be treated to normalise their blood pressure. In the elderly and very elderly (˃80 years), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations—fix combinations are preferred for increasing the adherence/persistence to therapy. Using diuretics, ACE inhibitors/ARBs with calcium antagonists and when needed diuretics and beta blockers are suggested by recent European guidelines. The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mmHg), but it seems to be wise to balance advantages/disadvantages, so the optimal SBP may be around 130 mmHg.

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Abbreviations

ACCOMPLISH:

Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension

ACEI:

Angiotensin-converting enzyme inhibitors

ARB:

Angiotensin AT-1 receptor antagonists

BBL:

Beta blockers

BP:

Blood pressure

BPLTTC:

Blood Pressure Lowering Treatment Trialists’ Collaboration

CCB:

Calcium channel blockers

CHD:

Coronary heart disease

CHEP:

Canadian Hypertension Educational Programme

CHF:

Congestive heart failure

CKD:

Chronic kidney disease

cPP:

Central pulse pressure

cSBP:

Central SBP

CV:

Cardiovascular

CVD:

Cardiovascular disease

DALY:

Disability-adjusted life-years

DBP:

Diastolic blood pressure

DIU:

Diuretics

eGFR:

Estimated glomerular filtration rate

ESC:

European Society of Cardiology

ESH:

European Society of Hypertension

EUROPA:

EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease

EWPHE:

European Working Party on High Blood Pressure in the Elderly

HOPE:

Heart Outcomes Prevention Evaluation

HR:

Hazard ratio

HTN:

Hypertension

HYVET:

Hypertension in the Very Elderly Trial

INSIGHT:

International Nifedipine GITS Study Intervention as a Goal in Hypertension Treatment

INVEST:

International Verapamil SR/Trandolapril Study

ISH:

Isolated systolic hypertension

JNC:

Joint National Committee

LIFE:

Losartan Intervention for Endpoint Reduction

MI:

Myocardial infarction

MRC:

Medical Research Council

NORDIL:

Nordic diltiazem

NSAID:

Nonsteroidal anti-inflammatory drug

NT:

Normotension

PP:

Pulse pressure

PROGRESS:

Perindopril Protection against Recurrent Stroke Study

PWV:

Pulse wave velocity

RAAS:

Renin-angiotensin-aldosterone system

RAS:

Renin-angiotensin system

RCT:

Randomised controlled trial

RR:

Relative risk

SAVE:

Survival and ventricular enlargement

SBP:

Systolic blood pressure

SCOPE:

Study on COgnition and Prognosis in the Elderly

SHEP:

Systolic Hypertension in the Elderly Program

SNS:

Sympathetic nervous system

SOLVD:

Studies of Left Ventricular Dysfunction

SPRINT:

Systolic Blood Pressure Intervention Trial

STONE:

Shanghai Trial of Nifedipine in the Elderly

Syst-China:

Systolic Hypertension in China

Syst-Eur:

Systolic Hypertension in Europe

WCH:

White coat hypertension

WHO-ISH:

World Heart Organisation-International Society of Hypertension

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Farsang, C. (2018). Isolated Systolic Hypertension: In the Young and in the Elderly. In: Berbari, A., Mancia, G. (eds) Disorders of Blood Pressure Regulation. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-59918-2_36

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