Elevated systolic blood pressure – extremely important predictor of cardiovascular risk Review article

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Published: Dec 31, 2010
Keywords:
systolic hypertension, isolated systolic hypertension, cardiovascular risk reduction

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Krystyna Widecka
Klinika Hipertensjologii i Chorób Wewnętrznych Pomorskiego Uniwersytetu Medycznego w Szczecinie

Abstract

Systolic blood pressure (SBP) increases with age in a distinct linear manner and is definitely the greatest therapeutic problem in patients with elevated blood pressure over the age of 50, which very often takes the form of isolated systolic hypertension (ISH). Based on the large epidemiological projects (NHANES III, WISHE, WHO MONICA), the problem affects about 65% of the general population of patients with poorly controlled hypertension and as much as 80% of patients over the age of 50. In the pathogenesis of age-related increased systolic blood pressure, the fundamental significance is attributed to the increasing stiffness of large arteries (the aorta and its branches), impaired vasodilation in response to β1-adrenergic receptor stimulation in the presence of preserved α-receptor stimulation, endothelial damage and age-related renal changes. The results of epidemiological observations of many years’ duration, such as the Framingham study or the MONICA project, have shown a proportional relationship between SBP and cardiovascular complications and renal failure already from the value of 115 mmHg. Stroke is a complication particularly closely associated with this relationship: an increase in SBP above 140 mmHg increases the risk of stroke 2.5-fold. Numerous clinical trials (SHEP, Syst-Eur, HYVET) have proved that drug therapy providing an effective SBP reduction significantly reduces the rate of cardiovascular complications. According to the current recommendations, in the management of elevated SBP (also in the form of ISH), none of the antihypertensive drug classes is considered superior and any of the five major antihypertensive drug classes may be used as the first-line treatment. In an overwhelming majority of cases it is necessary to use combination treatment with at least two agents. In any combination, diuretics play the key role with particular emphasis on thiazide-like diuretics (indapamide, chlorthalidone). Also, given the evidence from research supporting the improvement of vascular compliance, long-acting formulations of dihydropyridine channel antagonists and angiotensin-converting enzyme inhibitors may be preferred.

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How to Cite
Widecka, K. (2010). Elevated systolic blood pressure – extremely important predictor of cardiovascular risk. Medycyna Faktow (J EBM), 3(4(9), 38-48. Retrieved from https://journalsmededu.pl/index.php/jebm/article/view/2563
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Vol 3 No 4(9) (2010)
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Articles

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