Systolic hypertension
Systolic hypertension is defined as an elevated systolic blood pressure with a normal diastolic blood pressure. Sytolic hypertension may be due to reduced compliance of the aorta with increasing age[1].
Treatment
Two randomized-controlled trials have established the value of treating systolic hypertension[2][3].
SHEP study
This randomized-controlled trial showed a reduction of three strokes per 100 patients treated for five years[2][4]
- Patients: inclusion criteria were SBP greater than 160 to 219 mm Hg and DBP less than 90 mm Hg. Mean initial BP was 170/77.
- Treatment goal: 20 mmHg reduction in systolic pressure or a systolic pressure of less than 160 mm Hg, whichever was lower
- Mean final blood pressure in the treatment group: 143/68
Syst-Eur Trial
This randomized-controlled trial showed a reduction of 0.3 strokes per 100 patients treated for a median follow-up of two years[3].
- Patients: inclusion criteria were systolic of 160-219 mm Hg and diastolic blood pressure lower than 95 mm Hg. Average was 174/86.
- Treatment goal: "We aimed to reduce the sitting systolic blood pressure by at least 20 mm Hg to less than 150 mm Hg"
- Mean final blood pressure in the treatment group: 151/79. 44% of patients reached the target blood pressure goals.
The treatment goal
Based on these studiess, treating to a systolic pressure of 140, as long as the diastolic pressure is 68 or more seems safe. Corroborating this, a re-analysis of the SHEP data suggest that allowing the diastolic to go below 70 may increase adverse effects.[4].
References
- ↑ Smulyan H, Safar ME. The diastolic blood pressure in systolic hypertension. Ann Intern Med. 2000 Feb 1;132(3):233-7. PMID 10651605
- ↑ 2.0 2.1 6. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP) JAMA. 1991;265:3255-64. PMID 2046107 Cite error: Invalid
<ref>tag; name "pmid2046107" defined multiple times with different content - ↑ 3.0 3.1 Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators Lancet. 1997;350:757-64. PMID 9297994 Cite error: Invalid
<ref>tag; name "pmid9297994" defined multiple times with different content - ↑ 4.0 4.1 Somes GW, Pahor M, Shorr RI, Cushman WC, Appelgate WB. The role of diastolic blood pressure when treating isolated systolic hypertension Arch Intern Med. 1999;159:2004-9. PMID 8478043 Cite error: Invalid
<ref>tag; name "pmid8478043" defined multiple times with different content