A six-month trial of nonpharmacologic therapy followed by cautious, low-dose drug treatment is recommended for elderly patients with isolated systolic hypertension.
May support nonpharmacologic trial before low-dose drugs in elderly ISH; leaves open need for randomized confirmation.
The risk of stroke and myocardial infarction is increased in patients with elevated systolic blood pressure. Although treatment trials have demonstrated the benefit of antihypertensive therapy in elderly patients with diastolic hypertension, the only trial conducted in elderly patients with isolated systolic hypertension is currently in progress. A six-month trial of nonpharmacologic therapy should generally be the initial treatment in patients with isolated systolic hypertension. Then, if systolic pressure remains elevated, a cautious trial of drug treatment is reasonable. The drug used should be started in a low dose, and the dose should be titrated slowly. With this approach, antihypertensive treatment of elderly patients with isolated systolic hypertension may be well tolerated and ultimately beneficial.
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Cressman et al. (1989) studied this question.
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