TY - JOUR
T1 - Systolic Hypertension in the Elderly
T2 - Addressing an Unmet Need
AU - Duprez, Daniel A.
PY - 2008/3
Y1 - 2008/3
N2 - Systolic hypertension is a major public health issue in the elderly and is often under-recognized and under-treated. The concept that systolic blood pressure increases with age should be considered a pathophysiologic concept. Aging of the cardiovascular system is accompanied by endothelial dysfunction, activation of the renin-angiotensin system and, consequently, vascular remodeling. This process leads to an increase in large artery stiffness and an increase in arterial wave reflections to the heart. These processes in daily clinical practice translate to an increase in systolic blood pressure, which is associated with increased cardiovascular morbidity and mortality. Evidence-based medicine recommendations to treat systolic hypertension in the elderly are based on landmark and recent clinical trials, which clearly demonstrated that treatment of isolated systolic hypertension is associated with significant decreases in cardiovascular morbidity and mortality. However, treatment of systolic hypertension in older adults remains disappointing because therapeutic goals often are not reached. Therefore, emphasis should be placed on the treatment of systolic hypertension in the elderly, and there is need for more effective, individualized antihypertensive therapy.
AB - Systolic hypertension is a major public health issue in the elderly and is often under-recognized and under-treated. The concept that systolic blood pressure increases with age should be considered a pathophysiologic concept. Aging of the cardiovascular system is accompanied by endothelial dysfunction, activation of the renin-angiotensin system and, consequently, vascular remodeling. This process leads to an increase in large artery stiffness and an increase in arterial wave reflections to the heart. These processes in daily clinical practice translate to an increase in systolic blood pressure, which is associated with increased cardiovascular morbidity and mortality. Evidence-based medicine recommendations to treat systolic hypertension in the elderly are based on landmark and recent clinical trials, which clearly demonstrated that treatment of isolated systolic hypertension is associated with significant decreases in cardiovascular morbidity and mortality. However, treatment of systolic hypertension in older adults remains disappointing because therapeutic goals often are not reached. Therefore, emphasis should be placed on the treatment of systolic hypertension in the elderly, and there is need for more effective, individualized antihypertensive therapy.
KW - Angiotensin II
KW - Arterial stiffness
KW - Elderly
KW - Renin
KW - Systolic hypertension
KW - Vascular remodeling
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U2 - 10.1016/j.amjmed.2007.10.027
DO - 10.1016/j.amjmed.2007.10.027
M3 - Review article
C2 - 18328297
AN - SCOPUS:39849110460
SN - 0002-9343
VL - 121
SP - 179-184.e3
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 3
ER -