Manejo ng Isolated Systolic Hypertension
Dapat nang simulan ang antihypertensive medication para sa pasyenteng ito na may BP 156/70 mmHg, dahil ang systolic BP ay higit sa 130 mmHg at ang isolated systolic hypertension ay may malaking risk para sa cardiovascular events at mortality.
Rationale para sa Treatment
Ang BP reading na 156/70 mmHg ay nagpapakita ng isolated systolic hypertension (elevated systolic BP na may normal diastolic BP), na siyang pinakakaraniwan na uri ng hypertension sa mga matatanda 1. Ang ganitong pattern ay direktang nauugnay sa increased cardiovascular morbidity at mortality 2.
Target Blood Pressure
- Systolic BP target: <130 mmHg para sa karamihan ng adult patients, base sa 2017 ACC/AHA guidelines 1
- Diastolic BP safety margin: ≥70 mmHg dapat manatili during treatment para maiwasan ang tissue hypoperfusion 3
- Sa kasong ito, ang diastolic BP na 70 mmHg ay nasa safety margin pa, kaya pwedeng mag-initiate ng treatment nang ligtas 3
Treatment Algorithm
Step 1: Lifestyle Modifications (Immediate Implementation)
Habang nagsisimula ng pharmacologic therapy, dapat kasabay ang:
- Weight reduction kung overweight (target BMI 20-25 kg/m²) 4
- Sodium restriction to 1200-2300 mg/day 4, 5
- DASH diet na may 8-10 servings ng fruits at vegetables daily 4, 5
- Physical activity at limited alcohol intake 5
Step 2: Pharmacologic Treatment (Initiate Promptly)
First-line drug therapy para sa isolated systolic hypertension:
- Thiazide or thiazide-like diuretic (e.g., chlorthalidone, hydrochlorothiazide) - ito ang pinaka-evidence-based base sa SHEP trial 1, 2
- Alternative options kung may contraindications: ACE inhibitor (e.g., lisinopril) o calcium channel blocker (e.g., amlodipine) 1, 6, 5, 2
- Combination therapy ay madalas na kailangan para makamit ang target BP 1, 4, 5
Step 3: Monitoring Protocol
- Monthly evaluation ng BP at adherence hanggang makamit ang control 1
- Check orthostatic BP lalo na sa elderly patients para ma-detect ang postural hypotension 1
- Monitor electrolytes (potassium) within first 3 months kung gumagamit ng diuretics o RAS blockers 4, 7
Important Clinical Caveats
Diastolic BP Considerations
Ang diastolic BP na 70 mmHg ay critical threshold - dapat bantayan na hindi ito bumaba pa lalo during treatment 8, 3. Ang excessive diastolic BP lowering ay maaaring mag-reduce ng coronary perfusion pressure, lalo na sa patients na may coronary heart disease 8. Ang widened pulse pressure (156-70 = 86 mmHg) ay predictor ng cardiovascular risk 8.
Age-Specific Approach
Kung ang patient ay ≥65 years old, automatic high-risk category na siya at requires drug therapy at SBP ≥130 mmHg 1. Ang isolated systolic hypertension ay predominant form ng hypertension sa elderly, at proven effective ang treatment sa pag-reduce ng CVD events at mortality 1, 2.
Drugs to Avoid
- Beta-blockers as monotherapy - less effective para sa isolated systolic hypertension 1, 2, 9
- Dapat i-reserve ang beta-blockers para sa compelling indications tulad ng post-MI o heart failure 4
Expected Outcomes
Ang 10 mmHg reduction sa systolic BP ay nag-reduce ng cardiovascular events by approximately 20-30% 5. Ang treatment ng isolated systolic hypertension ay proven na nag-reduce ng stroke, myocardial infarction, at cardiovascular mortality 1, 2.
Titration Strategy
Kung hindi makamit ang target BP sa monotherapy:
- Add second agent from different class (e.g., ACE inhibitor + thiazide diuretic) 1, 4, 5
- Kung stage 2 hypertension (≥160/100 mmHg), pwedeng mag-start ng dual therapy agad 1, 7
Ang absence ng bruit ay good sign - walang evidence ng significant vascular stenosis, kaya straightforward ang treatment approach.