This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kaplan, N. M. Search for Related Content PubMed PubMed Citation Articles by Kaplan, N. M. Pubmed/NCBI databases Medline Plus Health Information High Blood Pressure Related Collections Secondary prevention Cerebrovascular disease/stroke Epidemiology

(Circulation. 2000;102:1079.)
© 2000 American Heart Association, Inc.

Editorial

New Issues in the Treatment of Isolated Systolic Hypertension

Norman M. Kaplan, MD

From the Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas.

Correspondence to Norman M. Kaplan, MD, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd (CS 8.102), Dallas, TX 75235-8899.

Key Words: Editorials • epidemiology • cerebrovascular disorders • prevention • hypertension

The newest hot issue in the field of hypertension relates to the oldest—isolated systolic hypertension (ISH) in the elderly. The article by Fagard et al¹ in this issue of Circulation provides important evidence about the response of ISH to antihypertensive therapy. Moreover, the implications of the evidence extend to the management of hypertension of any nature at any age.

Before commenting on the findings in this article, I will provide a bit of background. ISH is the most common form of hypertension in those older than 65 years.² Because this segment of the population is expanding so rapidly, ISH will soon be the most prevalent form of hypertension.

Over the last few years, a paradigm shift has occurred, away from the prior concern over an elevation of diastolic pressure to our current awareness that an elevation of systolic pressure and, to an even greater extent, the combination of higher systolic and lowered diastolic pressures (ie, a widening of the pulse pressure) are the major determinants of cardiovascular risk in the elderly.³ This should come as no surprise because the widening pulse pressure reflects atherosclerotic stiffening of the aorta and large capacitance vessels.⁴ This provides a smaller, rigid reservoir wherein systolic inflow raises pressure and diastolic emptying lowers pressure to a greater degree than occurs with more compliant, elastic vessels. In addition, pulse-wave velocity is faster through stiff vessels, so that the usual reflection of the pressure wave back from the periphery occurs in midsystole rather than diastole, augmenting the already . . . [Full Text of this Article]

This article has been cited by other articles:

				S. Aronson, M. L. Fontes, Y. Miao, D. T. Mangano, and for the Investigators of the Multicenter Study of Risk Index for Perioperative Renal Dysfunction/Failure: Critical Dependence on Pulse Pressure Hypertension Circulation, February 13, 2007; 115(6): 733 - 742. [Abstract] [Full Text] [PDF]

				S. Aronson, D. Boisvert, and W. Lapp Isolated Systolic Hypertension Is Associated with Adverse Outcomes from Coronary Artery Bypass Grafting Surgery Anesth. Analg., May 1, 2002; 94(5): 1079 - 1084. [Abstract] [Full Text] [PDF]

				P. A. van Zwieten Drug treatment of isolated systolic hypertension Nephrol. Dial. Transplant., June 1, 2001; 16(6): 1095 - 1097. [Full Text] [PDF]

				G. A. Beller Coronary Heart Disease in the First 30 Years of the 21st Century: Challenges and Opportunities : The 33rd Annual James B. Herrick Lecture of the Council on Clinical Cardiology of the American Heart Association Circulation, May 22, 2001; 103(20): 2428 - 2435. [Full Text] [PDF]