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

• Weight Loss

  Clinical trials have also documented the beneficial effects of weight loss, increased physical activity, and limiting alcohol consumption.In addition to lifestyle changes, medication can also be used to reduce systolic hypertension to safe levels, although [en.wikipedia.org]

  Regular exercise, weight loss and cutting down on salt in your diet might fix the problem without medication. If lifestyle changes aren’t enough, you’ll likely need medication. [askdoctork.com]

  Consider potential adverse effects of your treatment, especially in frail patients (as determined by slow gait speed, poor grip strength, signs of functional impairment, weight loss, or exhaustion). [acc.org]

  Weight loss - Losing 1.0 kg (2 pounds) body weight decreases blood pressure by 1.6/1.3 mmHg. It improves insulin sensitivity, sleep apnea, and decreased sodium sensitivity. [healthy-ojas.com]

  Sodium reduction and weight loss in the treatment of hypertension in older persons. JAMA. 1998 ; 279 :839–846. Crossref Medline Google Scholar 8 Fotherby MD, Potter JF. [circ.ahajournals.org]

• Abdominal Obesity

  Total and abdominal obesity among rural Chinese women and the association with hypertension. Nutrition 2012; 28 : 46–52. 64. Lee HS, Park YM, Kwon HS, Lee JH, Yoon KH, Son HY, Kim DS, Yim HW, Lee WC. [nature.com]

• Coronary Atherosclerosis

  Increased central aortic pulse pressure may play an important role in the pathogenesis and manifestation of carotid and coronary atherosclerosis rather than simply serving as a marker of the presence of disease. [hyper.ahajournals.org]

• 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]

  Treatment of hypertension in the elderly patient, particularly isolated systolic hypertension. http://www.uptodate.com/home. Accessed Feb. 6, 2017. Bavishi C, et al. Isolated systolic hypertension: An update after SPRINT. [mayoclinic.com]

  In 1927, Fineberg (2) first divided hypertensive patients into systolic and diastolic groups. Over the ensuing years, opinions about what is now called isolated systolic hypertension have changed markedly. [annals.org]

• Heart Disease

  They assert that “systolic hypertension” causes the heart disease. I believe cardiovascular disease is already present and causes the elevated systolic readings and widening pulse pressures. [rainsvillefamilypractice.org]

  The potential harm of further reducing the diastolic pressure with antihypertensive therapy, especially in patients with coronary heart disease, underlies the controversial "J curve." [ncbi.nlm.nih.gov]

  The potential harm of further reducing the diastolic pressure with antihypertensive therapy, especially in patients with coronary heart disease, underlies the controversial “J curve.” [annals.org]

• Vascular Disease

  BACKGROUND: Radiofrequency (RF) data technology is a newly developed method to evaluate vascular disease, especially subclinical atherosclerotic change. [ncbi.nlm.nih.gov]

  In most people, systolic blood pressure rises steadily with age due to the increasing stiffness of large arteries, long-term buildup of plaque and an increased incidence of cardiac and vascular disease. [heart.org]

  Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study. Circulation 1999;100:354-60. [ PUBMED ] 8. London GM, Guerin AP. [mjdrdypu.org]

  Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010;375:2215-22. [Pubmed] 5. UK Prospective Diabetes Study (UKPDS) Group. [nefrologiaaldia.org]

  Checking BP in both arms to assess for subclavian stenosis from atherosclerotic vascular disease is imperative, and using the highest value as the real BP is the standard of care. [acc.org]

• Left Ventricular Dysfunction

  We recently studied the prognostic importance of pulse pressure in patients with left ventricular dysfunction entered in the SOLVD trial. 16 In this population with left ventricular dysfunction and heart failure, pulse pressure was again associated with [hyper.ahajournals.org]

  These rates echo results of a post hoc analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Trial in which African-American patients with left ventricular systolic dysfunction did not appear to derive any antihypertensive (or mortality) benefit [guidelines.hypertension.ca]

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.

• Albuminuria

  Adding spironolactone to conventional antihypertensives reduces albuminuria in patients with diabetic nephropathy. Nat Clin Pract Nephrol 2006;2:310-1. [Pubmed] 55. Mehdi UF, Adams-Huet B, Raskin P, Vega GL, Toto RD. [nefrologiaaldia.org]

• Dyslipidemia

  Populations with obesity, diabetes or dyslipidemia, and patients who have hypertension combined with obesity and/or diabetes, should be aware of early preventive interventions. [ncbi.nlm.nih.gov]

  Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Statins, Acute Heart Failure, Exercise, [acc.org]

  This recommended dose largely based on a meta-analysis that reported greater benefits with low doses compared with high doses of thiazides in preventing cardiovascular events (25), and on studies reporting increased risks of metabolic side effects (dyslipidemia [guidelines.hypertension.ca]

• Ventricular Hypertrophy

  SH eventually compromises the left ventricle, resulting in left ventricular hypertrophy, coronary ischemia, and heart failure. [symptoma.com]

  Left ventricular hypertrophy was present in 100 % of patients, heart failure in 60 % nondippers and 56 % dippers, potential renal insufficiency in 34 % nondippers and 22 % dippers, retinopathy in 31 % non dippers and 11 % dippers, aortic aneurysm was [ncbi.nlm.nih.gov]

  This increases the load on the ventricle and compromises coronary blood flow, eventually resulting in left ventricular hypertrophy, coronary ischemia, and heart failure.Contemporary science shows an immersed boundary method of computational illustration [en.wikipedia.org]

  Left ventricular hypertrophy (LVH), diastolic dysfunction, and systolic dysfunction were evaluated on 2D echocardiography and correlated with the pulse pressure. [mjdrdypu.org]

If the goal was not reached at the first step, treatment with atenolol, 25 mg/d, was added (second step). If atenolol treatment was not tolerated, treatment with reserpine, 0.05 mg/d, could be substituted. [doi.org]

In older persons, hypertension treatment decisions must often rely on extrapolations and fall into a gray area where optimal choice for an individual patient may be unclear. [ncbi.nlm.nih.gov]

For healthy adults who are age 65 or older, the recommended treatment goal for systolic pressure is also less than 130 mm Hg. [mayoclinic.com]

This is the only group with ISH shown to have an adverse prognosis and to warrant drug therapy. [ncbi.nlm.nih.gov]

CONCLUSIONS: Our study suggests that genetic variants in systolic pressure-related genotypes may contribute to the etiology of ischemic stroke. [ncbi.nlm.nih.gov]

Systolic Hypertension Speaker PPTs Ekambaram Umapathy An association between vasoactive agents and etiology of hypertension and obesity in HIV patients in Mthatha, South Africa PPT Version | PDF Version Roberto Antonio Flores Control and monitoring of [omicsonline.org]

NC, USA. 3 Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA. [ncbi.nlm.nih.gov]

Mercedes Carnethon, PhD, associate professor in Preventive Medicine-Epidemiology, Kiang Liu, PhD, professor in Preventive Medicine-Epidemiology and Medicine-General Internal Medicine and Geriatrics, Philip Greenland, MD, Harry W. [news.feinberg.northwestern.edu]

Among various pathophysiological changes associated with aging, excess body weight and insulin resistance may predispose to this type of hypertension. [ncbi.nlm.nih.gov]

Mercedes Carnethon, PhD, associate professor in Preventive Medicine-Epidemiology, Kiang Liu, PhD, professor in Preventive Medicine-Epidemiology and Medicine-General Internal Medicine and Geriatrics, Philip Greenland, MD, Harry W. [news.feinberg.northwestern.edu]

Isolated systolic hypertension can lead to serious health problems, such as: Stroke Heart disease Chronic kidney disease Your high blood pressure will need to be controlled with medications in order to prevent health problems. [mayoclinic.com]

Further studies need to determine whether excessively low DBP can be prevented by more careful titration of antihypertensive therapy while maintaining SBP control. [ncbi.nlm.nih.gov]

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.