Key result
Antihypertensive treatment of isolated systolic hypertension reduces elderly morbidity and mortality, favoring thiazides and CCBs.
Why the study?
Isolated systolic hypertension accounts for up to 80% of hypertension cases in older patients, prompting a need to appraise evidence on blood pressure control and the impact of different drug regimens on outcomes.
Does antihypertensive treatment reduce morbidity and mortality in elderly patients with isolated systolic hypertension?
Systematic Review
Does antihypertensive treatment reduce morbidity and mortality in elderly patients with isolated systolic hypertension?
Antihypertensive treatment, primarily with thiazide diuretics and calcium-channel blockers, significantly reduces morbidity and mortality in elderly patients with isolated systolic hypertension.
Supports treating elderly ISH with thiazides or CCBs; confirms mortality benefit via Level 1 evidence.
INTRODUCTION: Hypertension is a major and modifiable risk factor for cardiovascular disease. Its prevalence is rising as the result of population aging. Isolated systolic hypertension mostly occurs in older patients accounting for up to 80% of cases. AREAS COVERED: The authors systematically review published studies to appraise the scientific and clinical evidence supporting the role of blood pressure control in elderly patients with isolated systolic hypertension, and to assess the influence of different drug treatment regimens on outcomes. EXPERT OPINION: Antihypertensive treatment of isolated systolic hypertension significantly reduces the risk of morbidity and mortality in elderly patients. Thiazide diuretics and dihydropyridine calcium-channel blockers are the primary compounds used in randomized clinical trials. These drugs can be considered as first-line agents for the management of isolated systolic hypertension. Free or fixed combination therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and calcium-channel blockers or thiazide-like diuretics should also be considered, particularly when compelling indications such as coronary artery disease, chronic kidney disease, diabetes, and congestive heart failure coexist. There is also hot scientific debate on the optimal blood pressure target to be achieved in elderly patients with isolated systolic hypertension, but current recommendations are scarcely supported by evidence.
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Angeli et al. (2020) conducted a systematic review in Isolated systolic hypertension. Antihypertensive treatment (thiazide diuretics, calcium-channel blockers, ACE inhibitors, ARBs) was evaluated on Morbidity and mortality. Antihypertensive treatment of isolated systolic hypertension significantly reduces morbidity and mortality in elderly patients, with thiazide diuretics and calcium-channel blockers as first-line agents.
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