Isolated Systolic Hypertension: In the Young and in the Elderly

Prevalence of the isolated increase in systolic blood pressure ≥140 mmHg with normal or low diastolic blood pressure ≤80 mmHg is defined as isolated systolic hypertension. Its prevalence increases with age up to ˃90% in patients aged ˃90 years. Isolated systolic hypertension is also found in the young and the clinical significance of it is still debated. For the therapy, those drugs should be used which have a licence for use in children: angiotensin-converting enzyme inhibitors, angiotensin AT-1 receptor antagonists, calcium channel blockers beta blockers and diuretics and their combinations. The young adults with isolated systolic hypertension had a much higher risk of dying from coronary heart disease or cardiovascular disease, then the normotensive individuals, and should be treated to normalise their blood pressure. In the elderly and very elderly (˃80 years), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations—fix combinations are preferred for increasing the adherence/persistence to therapy. Using diuretics, ACE inhibitors/ARBs with calcium antagonists and when needed diuretics and beta blockers are suggested by recent European guidelines. The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mmHg), but it seems to be wise to balance advantages/disadvantages, so the optimal SBP may be around 130 mmHg.