From the Guidelines
Isolated systolic hypertension is a condition where the systolic blood pressure is elevated to 140 mmHg or higher, while the diastolic pressure remains normal at less than 90 mmHg, and it is particularly common in older adults due to age-related stiffening of the arteries. This condition is a significant risk factor for stroke, heart disease, and kidney problems, and its management is crucial to prevent these complications.
- The treatment of isolated systolic hypertension typically involves lifestyle modifications, such as reducing sodium intake, maintaining a healthy weight, regular exercise, limiting alcohol, and quitting smoking.
- When medications are needed, first-line options often include thiazide diuretics (like chlorthalidone 12.5-25 mg daily or hydrochlorothiazide 12.5-25 mg daily), calcium channel blockers (such as amlodipine 5-10 mg daily), or ACE inhibitors (like lisinopril 10-40 mg daily) 1.
- Treatment goals generally aim for a systolic pressure below 130-140 mmHg, though targets may be individualized based on age and comorbidities 1.
- Studies have shown that controlling isolated systolic hypertension can significantly reduce the risk of stroke, with a 42% risk reduction found in the Systolic Hypertension in Europe (Syst-Eur) Trial and a 36% reduction found in the Systolic Hypertension in the Elderly Program (SHEP) Trial 1.
- The American Heart Association recommends that adult patients undergo routine screening for hypertension at least every two years 1. The most effective approach to managing isolated systolic hypertension is to use a combination of lifestyle modifications and medications, with a goal of reducing systolic blood pressure to less than 130-140 mmHg, and this approach can significantly reduce the risk of stroke, heart disease, and kidney problems 1.
From the FDA Drug Label
Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit There is no direct information in the provided drug label that defines isolated Systolic Hypertension. The FDA drug label does not answer the question.
From the Research
Definition of Isolated Systolic Hypertension
- Isolated systolic hypertension (ISH) is a disorder typically defined when the systolic blood pressure (BP) is greater than 140 mm Hg but with diastolic BP below 90 mm Hg 2.
- It is a condition where the systolic blood pressure is elevated, but the diastolic blood pressure is normal 3, 4, 5.
- ISH is often associated with aging and is characterized by increased arterial stiffness, particularly in the aorta and other elastic arteries 6.
Pathophysiology of Isolated Systolic Hypertension
- Aging is associated with deterioration in arterial compliance, leading to increased arterial stiffness and a decrease in the lumen-to-wall ratio 6.
- Functional changes, such as increased sympathetic system activity and decreased sensitivity of beta-receptors, also contribute to the development of ISH 6.
- The increased pulse pressure in ISH is an independent marker of cardiovascular risk, indicating reduced vascular compliance of large arteries 2.
Consequences of Isolated Systolic Hypertension
- ISH is a major cardiovascular risk factor, associated with increased mortality and morbidity, including non-fatal stroke and myocardial infarction 6.
- The risk of cardiovascular disease is higher in patients with ISH, particularly in those with concomitant risk factors such as diabetes, angina pectoris, and left ventricular hypertrophy 6.
- ISH is also associated with increased risk of sudden death, stroke, and all fatal and non-fatal cardiac end-points 6.
Treatment of Isolated Systolic Hypertension
- Antihypertensive treatment of ISH significantly reduces the risk of morbidity and mortality in elderly patients 4.
- Thiazide diuretics and dihydropyridine calcium-channel blockers are commonly used as first-line agents for the management of ISH 4.
- ACE inhibitors and angiotensin receptor blockers may also be considered, particularly in patients with compelling indications such as coronary artery disease, chronic kidney disease, diabetes, and congestive heart failure 4, 3.