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Treatment strategies for isolated systolic hypertension in elderly patients

Fabio Angeli, Paolo Verdecchia, Sergio Masnaghetti, Gaetano Vaudo & Gianpaolo Reboldi

1713-1723, Jun 2020, Expert Opinion on Pharmacotherapy

Volume 21, 2020 - Issue 14

Unsolved Problem: (Isolated) Systolic Hypertension with Diastolic Blood Pressure below the Safety Margin

Koracevic G.a,b · Stojanovic M.c · Kostic T.a,b · Lovic D.d · Tomasevic M.e · Jankovic-Tomasevic R.a

What’s new in the ESC 2018 guidelines for arterial hypertension

Jutta Bergler-Klein

Eighty percent of people with systolic hypertension are over the age of 65 years old.

Treatment
The goal of treating systolic hypertension is to delay and reduce the extent of damage to the heart, the cerebrovascular system, and the kidneys. This also decreases the risk of cardiovascular disease and morbidity. Lifestyle interventions are alternative solutions to treating systolic hypertension. Examples include a low sodium diet (salt) and rich in whole grains, fruits, and vegetables.

A low sodium diet should contain a maximum sodium intake of 2.0 grams (approximately 5.0 grams of salt). Additional salt and processed foods should be avoided. For hypertensive men, alcoholic drinks should be reduced to 14 units per week. For hypertensive women, alcoholic drinks should be reduced to 8 units per week. (1 unit corresponds to 1/8 liter of wine or 1/4 liter of beer).

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.

Common medications used to treat systolic hypertension include a thiazide-type diuretic (TTD) or calcium channel blockers (CCB), or a combination of the two.

Goals
In 2019, a systematic review and meta-analysis of antihypertensive treatment trials in elderly patients with isolated systolic hypertension demonstrated results with the intensive decrease of SBP to <140 mm Hg. All cause mortality was diminished for 24% and cardiovascular mortality for 39%