Isolated systolic hypertension: Cardiovascular risk and treatment benefits

Pathogenetic factors: Age-related vascular and neurohumoral changes are important factors leading to the development of hypertension and particularly of ISH. Arterial compliance deteriorates because of structural and functional changes and increases is collagen, extracellular protein matrix, ground substance, elastin that occur with age. These changes create structural and mechanical alterations in the vessel intima and media. Calcium binds to the elastin, and undifferentiated muscle cells of the media proliferate and migrate through the elastic laminae to the intima. The proliferation of the connective tissue results in intimal thickening and fibrosis, increases the stiffness of the vessels with partial loss of contractility. Consequently, arterial compliance diminishes and the so called „windkessel function of the large arteries decreases. Pulse pressure and pulse wave velocity increase with an earlier reflection of pressure waves from the periphery, to a disproportionate increase in systolic blood pressure. Consequently, systolic blood pressure increases while diastolic blood pressure does not change or decreases particularly over the age of 60 (3, 4, 5).Cardiac output, stroke volume, intravascular volume, renal blood flow and plasma renin activity decrease, while left ventricular mass (prevalence of left ventricular hyperthrophy - LVH), circulating catecholamines, particularly noradrenaline, and total peripheral vascular resistance increase. Baroreceptor sensitivity to blood pressure changes also decreases causing a higher blood pressure variability.