SH is not generally associated with clinical symptoms. However, patients with severe hypertension may experience non-specific dizziness, recurrent headaches and blurred vision. In some cases, they may suffer from syncopes. Interestingly, the latter are not provoked by an increased arterial blood pressure, but by an episode of hypotension and consequently decreased cerebral perfusion. People suffering from chronic hypertension have been shown to be more prone to syncopes than the general population [5]. Patients may also report to perceive a ringing in their ears, may claim dyspnea or angina. In general, the prevalence of symptoms attributed to hypertension amounts to about a third of hypertensive patients and a fifth of normotensives [6].

As has been indicated above, SH patients have relatively high risks of cardiovascular accidents. Indeed, any of the following events and conditions may be the first manifestation of systolic hypertension [7]:

• Heart disease, e.g., left ventricular hypertrophy, coronary ischemia, myocardial infarction, atrial fibrillation, and heart failure
• Thoracic aortic aneurysm/abdominal aortic aneurysm
• Peripheral artery disease
• Cerebrovascular accident
• Hypertensive retinopathy
• Renal failure

• Hypertension

  BACKGROUND: Renal sympathetic denervation seems to be less effective as a treatment for hypertension in patients with isolated systolic hypertension, a condition associated with elevated central arterial stiffness. [ncbi.nlm.nih.gov]

• Recurrent Headache

  However, patients with severe hypertension may experience non-specific dizziness, recurrent headaches and blurred vision. In some cases, they may suffer from syncopes. [symptoma.com]

Workup aims at [8]:

• Determining blood pressure levels
• Identifying possible causes of SH
• Assessing the patient's overall cardiovascular risk

Repeated measurements of arterial blood pressure are required to support a diagnosis of SH. Because they are ideally realized at home, ambulatory blood pressure measurements are becoming increasingly popular [9]. The latter should be complemented with office measurements, though, and those should be realized at least thrice, with the patient adopting a supine and sitting position. With regards to possible causes of SH and the patient's individual risk of sustaining cardiovascular accidents, a thorough anamnesis, general and ophthalmological examination, laboratory analyses of blood and urine samples should be performed. Cardiac function may be assessed by means of echocardiography and electrocardiography [10]. Patients are to undergo regular follow-ups comprising similar studies.

Systolic hypertension (SH) is defined as an arterial blood pressure exceeding 140 mmHg [1], and is a major health problem affecting more than half of the elder population of both developing and developed countries worldwide [2]. SH eventually compromises the left ventricle, resulting in left ventricular hypertrophy, coronary ischemia, and heart failure.

It has been shown that an early-returning and magnified pulse-wave reflection significantly contributes to the onset of SH [3], and this condition is most pronounced in close proximity to the heart. Physiologically, the aorta is exposed to highest systolic blood pressures. Blood is ejected from the left ventricle of the heart, reaches the aorta and dilates this large vessel. The subsequent, slow contraction of the aortic wall - commonly known as Windkessel effect - partially compensates for pressure fluctuations and assures a rather smooth pulse wave to be delivered to the periphery. However, reduced arterial compliance interferes with this process in individuals suffering from SH. Besides age, a variety of genetic and environmental factors are assumed to contribute to increasing arterial stiffness in these patients. In sum, reduced aortic compliance and distensibility have been shown to be strong predictors of cardiovascular morbidity and mortality [4].

1. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens. 1999; 17(2):151-183.
2. Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. JRSM Cardiovasc Dis. 2012; 1(4).
3. Flaa A, Aksnes TA, Strand A, Kjeldsen SE. Complications of hypertension and the role of angiotensin receptor blockers in hypertension trials. Expert Rev Cardiovasc Ther. 2007; 5(3):451-461.
4. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007; 28(12):1462-1536.
5. Middeke M, Lemmer B, Schaaf B, Eckes L. Prevalence of hypertension-attributed symptoms in routine clinical practice: a general practitioners-based study. J Hum Hypertens. 2008; 22(4):252-258.
6. Miller TH, Kruse JE. Evaluation of syncope. Am Fam Physician. 2005; 72(8):1492-1500.
7. O'Brien E, Parati G, Stergiou G. Ambulatory blood pressure measurement: what is the international consensus? Hypertension. 2013; 62(6):988-994.
8. Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens. 2009; 27(5):963-975.
9. Stokes GS. Treatment of isolated systolic hypertension. Curr Hypertens Rep. 2006; 8(5):377-383.
10. Ural D, Komsuoglu B, Cetinarslan B, Leventyuz M, Goldeli O, Komsuoglu SS. Echocardiographic features and QT dispersion in borderline isolated systolic hypertension in the elderly. Int J Cardiol. 1999; 68(3):317-323.