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Diagnostic and therapeutic problems of isolated systolic hypertension

Mancia, Giuseppea; Giannattasio, Cristinab

doi: 10.1097/HJH.0000000000000424

Prevalence of isolated systolic hypertension increases with age, due to progressive elevation of SBP, and is a major risk factor for cardiovascular morbidity and mortality. Extensive research has shown that lowering SBP improves cardiovascular outcomes in patients with isolated systolic hypertension, yet SBP control rates remain largely inadequate regardless of antihypertensive treatment. Arterial stiffness is a major determinant of elevated SBP resulting from structural changes in the vascular system, mediated by neurohormonal alterations that occur with vascular ageing. Clinical data have demonstrated an independent association between arterial stiffness and cardiovascular outcomes. Therefore, arterial stiffness has the potential to be an important therapeutic target in the management of isolated systolic hypertension. Current antihypertensive treatments have limited effects on arterial stiffness, so the development of new treatments addressing neurohormonal alterations central to vascular ageing is important. Such therapies may represent effective strategies in the future management of SBP.

aIRCCS Istituto Auxologico Italiano, Milan and University of Milano-Bicocca

bMilano-Bicocca University and Cardiology IV, Niguarda Ca Granda Hospital, Milan, Italy

Correspondence to Giuseppe Mancia, Piazza dei Daini, 4, 20126 Milan, Italy. Tel: +39 039 233 3357; fax: +39 039 322274; e-mail:

Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; BP, blood pressure; CCB, calcium channel blocker; CKD, chronic kidney disease; D, diastolic; HYVET, Hypertension in the very elderly; INVEST, International Verapamil SR Trandolapril Study; NHANES, National Health and Nutrition Examination Survey; PWV, pulse wave velocity; S, systolic; SHEP, Systolic Hypertension in the Elderly Program; SPARTE, Strategie de Prevention Cardiovasculaire basé sur la Ripidité Arterielle; STOP, Swedish Trial in Old Patients with Hypertension; SYST-CHINA, Systolic Hypertension in China; SYSTEUR, Systolic Hypertension in Europe

Received 11 February, 2014

Revised 15 September, 2014

Accepted 16 September, 2014

© 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins