Isolated systolic hypertension spot lights

Isolated systolic hypertension spot lights
Prof. Dr. Ahmed A.rozza Md, Facc,Fesc, Fasc
Prof. Of Cariovascular Medicine
Alazhar Medical School
Hypertension is a major cardiovascular risk factor that contributes to any cardial infraction, cerebrovascular accidents, sugestive heart failure, peripheral arterial insufficiency and premature mortality,
approximately about 20 - 25% of total population of any community showing a degree of high blood pressure including isolated systolic hypertension.
definition
the joint national committee on the detection. evaluation, and treatment of high blood pressure has defined it as indirect sphygnomanometric level of ≥ 140 mm Hg systolic and/or ≥ 90 mm Hg diastolic as in table (1).
Table (1):
bpclassification (adult ≥ 18; not taking antihypertertsive drugs and
Etiology of elevated dbpand sbp; the pathogenest of primary hypertension involves both genetic and environmental variables.
The disease is characterized by increased systemic resistance associated with vasoconstriction and vascular hypertrophy.
An age related increased arterial stiffness (arterial coympliance ) accompanies the high prevalence of elevated systolic BP in older patients. a decrease in the elastin content and increase in both collagen and glycosaminoglycans contribute to reduced compliance.
All of these structural changes are accelerated in patients with hypertension.
The age-related increase in arterial stiffness is associated with changes in several hemodynamic variables in addition to SBP.
Among 2036 participants in the fromingham study, SBP, mean arterial pressure and pulse pressure all increased progressively with age while DBP increase and then declined predicting cardiovascular risk.
The morbidity and mortality of hypertension are well established.
Evidence indicates that SBP is a powerful predictor at cardiovascular risk in hypertensive patient, with an importance substantially exceeding that of DBP. SBP is a much more powerful predictor at cardiovascular disease than DBP.
Numerous epidemiology studies have confirmed the increased risks of
cardiovascular and related diseases that accompany elevated SBP.
They support the conclusion that elevated SBP, more than high DBP increase that risks (table 2).
Table (2):
incrensed risk of cardiovascular and related disease in individuals with elevated SBP. A study of 11912 hypertensive US veterans showed significant and increasing risk of end stage renal disease with rising SBP.
The risk ratio was 2.8 for SBP of 165 to 180 mm Hg and increased to 7.6 for SBP > 180 mm Hg.
Similarly, in the multiple risk factor intervention Trial ( MRFIT ) which screened 332.554 men , elevated SBP increased the risk of end stage renal disease, and excess risk rose with increasing SBP.
Evidence from Major therapeutic trials supports improved patients outcome:
Effective antihypertensive therapy has the potential to significantly decrease cardiovascular morbidity and mortality in older patients with elevated SBP.
Two large, long term, placebo- controlled clinical trials have demonstrated significant reduction in cardiovascular risk for older patients with elevated SBP.
The systolic hypertension in the elderly program (SHEP n = 4800 patients ≥ 60 years with SBP 160 to 219 mm Hg and DBP SHEP and sys-Eur demonstrated that antihypertensive drug therapy for older patients with high SBP reduce the risk of stroke and other cardiovascular events ( table 3 )

≥ 2.8 Kidney failure
≥ 2.7 Stroke
≥ 1.5 Heart failure
≥ 1.8 Peripheral arterial disease
≥ 1.6 Myocardial infraction
≥ 1.5
Coronary artery disease
Thble (3): key results fromshepand syst-Eur

SHEP
n = 2398 SHEP
n = 4800
23 (10) 27 (11) A Reduction in SBP mm Hg
Risk reduction %
14 13 All cause mortality
31 32 All cardiovascular mortality
42 36 Fatal and nonfatal stroke
26 25 Cordiac end points
SUMMARY
Hypertension as currently defined affects about 20% of adults in most developed countries.
Although many hypertensive patients have elevation of both SBP and DBP, high SBP is particularly common in older patients and becomes the dominant form of hypertension in individuals ≥ 60 years of age high SBP places individuals at substantially increased risk of mortality, cardiovascular events (stroke, MI, AF, heart failure, and peripheral vascular disease) and renal impairment. Several studies have demonstrated further that SBP is a stronger predictor of risk than DBP.
A large-scale. long-term clinical trials have made clear, lowering BD can significantly decrease candiovascular risk. Results of SHEP and syst-Eur showed that treating high SBP can also significantly improves outcomes.