Key Points
- To review the pathophysiological significance, cardiovascular risks, and therapeutic strategies associated with systolic blood pressure elevation and isolated systolic hypertension in elderly populations.
- Narrative review examining clinical evidence and treatment guidelines for hypertension in adults aged 65 years and older.
- Evaluated hemodynamic changes with aging, cardiovascular endpoints, and comparative efficacy of lifestyle modifications and antihypertensive pharmacotherapies.
- Reduced vascular compliance after age 60 shifts cardiovascular risk from diastolic to systolic blood pressure elevation and widened pulse pressure, making isolated systolic hypertension the predominant subtype.
- Initial therapy with diuretic- or calcium channel blocker-based regimens improves clinical outcomes when systolic blood pressure is ≥160 mm Hg and diastolic is <90 mm Hg, whereas alpha blocker monotherapy should be avoided.
- Achieving the blood pressure target of <140 mm Hg typically requires two to three antihypertensive drugs, while gradual titration is necessary to avoid lowering diastolic blood pressure below 55 mm Hg.
Structured PICO
PPopulationElderly individuals (65 years of age and older) with hypertension, particularly isolated systolic hypertension
IInterventionLifestyle modification (weight loss, salt restriction) and pharmacologic therapy (diuretic-based or calcium channel blocker-based regimens)
This review highlights the importance of treating isolated systolic hypertension in the elderly with diuretics or calcium channel blockers to a target of <140 mm Hg, while avoiding excessive diastolic blood pressure reduction.