Systolic hypertension
This article needs to be updated.(January 2017) |
Systolic hypertension | |
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Specialty | Cardiology |
In medicine, systolic hypertension is defined as an elevated systolic blood pressure (SBP).[1] If the systolic blood pressure is elevated (>140) with a normal (<90) diastolic blood pressure (DBP), it is called isolated systolic hypertension.[2] Eighty percent of people with systolic hypertension are over the age of 65 years old.[3] Isolated systolic hypertension is a specific type of widened (or high) pulse pressure.
Causes
Systolic hypertension may be due to reduced compliance of the aorta with increasing age.[4] This increases the load on the ventricle and compromises coronary blood flow, eventually resulting in left ventricular hypertrophy, coronary ischemia, and heart failure.[5]
Contemporary science shows an immersed boundary method of computational illustration of a single heartbeat. Applied to physiologic models, immersed boundary theory sees the heart as a great folded semisolid sail fielding and retrieving a viscous blood mass. The sail, likened to Windkessel effect physiology, gives and receives a load under time-ordered phases. Decreasing compliance of the sail heralds the onset of systolic hypertension.[6]
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.
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 also be avoided.
Clinical trials have also documented the beneficial effects of weight loss, increased physical activity, and limiting alcohol consumption.[5] 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).[7]
In addition to lifestyle changes, medication can also be used to reduce systolic hypertension to safe levels.[8][9]
Common medications used to treat systolic hypertension include a thiazide-type diuretic (TTD) or calcium channel blockers (CCB), or a combination of the two.[10]
Goal
Based on these studies, treating to a
A
- The low value of 85 mm Hg for treated hypertensives in the meta-analysis is higher than the value of 68–70 mm Hg that is suggested by the two major randomized controlled trials of isolated systolic hypertension
- The two largest trials in the meta-analysis, Hypertension Detection and Follow-up Program (HDFP)[14] and Medical Research Council trial in mild hypertension (MRC1)[15] were predominantly middle-aged subjects, all of whom had diastolic hypertension before treatment.
- The independent contributions of diseases and factors other than hypertension versus effects of treatment are not clear in the meta-analysis.
An updated 2020 Cochrane review found that in the general population of individuals with elevated blood pressure interventions to achieve a lower blood pressure target beyond a standard (≤ 140/90 mm Hg) create more harms than no intervention.[16] Further research is needed, the results of this review were applicable mainly to older individuals with moderate to high cardiovascular risk.[16]
In 2019, a systematic review of anti-hypertensive 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%[17]
References
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- ^ "Guideline for the diagnosis and management of hypertension in adults" (PDF). Australian Heart Foundation. 2016. p. 12. Archived from the original (PDF) on 14 January 2017. Retrieved 20 July 2017.
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- ^ a b DeLoach SS, Townsend RR (March 2008). "Systolic Hypertension: A Guide to Optimal Therapy". Consultant. 48 (3). Archived from the original on 2013-01-19.
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