Systolic hypertension

Last updated
Systolic hypertension
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.

Contents

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. Lifestyle interventions are alternative solutions to treating systolic hypertension. Examples include a diet low in sodium (salt) and rich in whole grains, fruits, and vegetables.

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 systolic blood pressure of 140, as long as the diastolic blood pressure is 68 or more, seems safe. [11] Corroborating this, a reanalysis of the SHEP data suggests allowing the diastolic to go below 70 may increase adverse effects. [12]

A meta-analysis of individual patient data from randomized controlled trials found the lowest diastolic blood pressure for which cardiovascular outcomes improve is 85 mm Hg for untreated hypertensives and 80 mm Hg for treated hypertensives. [13] The authors concluded "poor health conditions leading to low blood pressure and an increased risk for death probably explain the J-shaped curve". [13] Interpreting the meta-analysis is difficult, but avoiding a diastolic blood pressure below 68–70 mm Hg seems reasonable because:

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]

Related Research Articles

<span class="mw-page-title-main">Blood pressure</span> Pressure exerted by circulating blood upon the walls of arteries

Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" refers to the pressure in a brachial artery, where it is most commonly measured. Blood pressure is usually expressed in terms of the systolic pressure over diastolic pressure in the cardiac cycle. It is measured in millimeters of mercury (mmHg) above the surrounding atmospheric pressure, or in kilopascals (kPa). The difference between the systolic and diastolic pressures is known as pulse pressure, while the average pressure during a cardiac cycle is known as mean arterial pressure.

<span class="mw-page-title-main">Hypertension</span> Long-term high blood pressure in the arteries

Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. It is, however, a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia. Hypertension is a major cause of premature death worldwide.

Orthostatic hypotension, also known as postural hypotension, is a medical condition wherein a person's blood pressure drops when standing up or sitting down. Primary orthostatic hypotension is also often referred to as neurogenic orthostatic hypotension. The drop in blood pressure may be sudden, within 3 minutes or gradual. It is defined as a fall in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg after 3 minutes of standing. It occurs predominantly by delayed constriction of the lower body blood vessels, which is normally required to maintain adequate blood pressure when changing the position to standing. As a result, blood pools in the blood vessels of the legs for a longer period, and less is returned to the heart, thereby leading to a reduced cardiac output and inadequate blood flow to the brain.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Pulse pressure</span> Difference between systolic and diastolic blood pressure

Pulse pressure is the difference between systolic and diastolic blood pressure. It is measured in millimeters of mercury (mmHg). It represents the force that the heart generates each time it contracts. Healthy pulse pressure is around 40 mmHg. A pulse pressure that is consistently 60 mmHg or greater is likely to be associated with disease, and a pulse pressure of 50 mmHg or more increases the risk of cardiovascular disease. Pulse pressure is considered low if it is less than 25% of the systolic. A very low pulse pressure can be a symptom of disorders such as congestive heart failure.

<span class="mw-page-title-main">Hydrochlorothiazide</span> Diuretic medication

Hydrochlorothiazide, sold under the brand name Hydrodiuril among others, is a diuretic medication used to treat hypertension and swelling due to fluid build-up. Other uses include treating diabetes insipidus and renal tubular acidosis and to decrease the risk of kidney stones in those with a high calcium level in the urine. Hydrochlorothiazide is taken by mouth and may be combined with other blood pressure medications as a single pill to increase effectiveness. Hydrochlorothiazide is a thiazide medication which inhibits reabsorption of sodium and chloride ions from the distal convoluted tubules of the kidneys, causing a natriuresis. This initially increases urine volume and lowers blood volume. It is believed to reduce peripheral vascular resistance.

Antihypertensives are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke, heart failure, kidney failure and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21%, and can reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. There are many classes of antihypertensives, which lower blood pressure by different means. Among the most important and most widely used medications are thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers.

<span class="mw-page-title-main">Indapamide</span> Thiazide diuretic drug

Indapamide is a thiazide-like diuretic drug used in the treatment of hypertension, as well as decompensated heart failure. Combination preparations with perindopril are available. The thiazide-like diuretics reduce risk of major cardiovascular events and heart failure in hypertensive patients compared with hydrochlorothiazide with a comparable incidence of adverse events. Both thiazide diuretics and thiazide-like diuretics are effective in reducing risk of stroke. Both drug classes appear to have comparable rates of adverse effects as other antihypertensives such as angiotensin II receptor blockers and dihydropyridine calcium channel blockers and lesser prevalence of side-effects when compared to ACE-inhibitors and non-dihydropyridine calcium channel blockers.

Essential hypertension is a form of hypertension without an identifiable physiologic cause. It is the most common type affecting 85% of those with high blood pressure. The remaining 15% is accounted for by various causes of secondary hypertension. Essential hypertension tends to be familial and is likely to be the consequence of an interaction between environmental and genetic factors. Hypertension can increase the risk of cerebral, cardiac, and renal events.

<span class="mw-page-title-main">Mean arterial pressure</span> Average blood pressure in an individual during a single cardiac cycle

In medicine, the mean arterial pressure (MAP) is an average calculated blood pressure in an individual during a single cardiac cycle. Although methods of estimating MAP vary, a common calculation is to take one-third of the pulse pressure, and add that amount to the diastolic pressure. A normal MAP is about 90 mmHg.

<span class="mw-page-title-main">Reserpine</span> Drug used to treat high blood pressure

Reserpine is a drug that is used for the treatment of high blood pressure, usually in combination with a thiazide diuretic or vasodilator. Large clinical trials have shown that combined treatment with reserpine plus a thiazide diuretic reduces mortality of people with hypertension. Although the use of reserpine as a solo drug has declined since it was first approved by the FDA in 1955, the combined use of reserpine and a thiazide diuretic or vasodilator is still recommended in patients who do not achieve adequate lowering of blood pressure with first-line drug treatment alone. The reserpine-hydrochlorothiazide combo pill was the 17th most commonly prescribed of the 43 combination antihypertensive pills available In 2012.

<span class="mw-page-title-main">Hypertensive emergency</span> Profoundly elevated blood pressure resulting in symptomatic end-organ injury

A hypertensive emergency is very high blood pressure with potentially life-threatening symptoms and signs of acute damage to one or more organ systems. It is different from a hypertensive urgency by this additional evidence for impending irreversible hypertension-mediated organ damage (HMOD). Blood pressure is often above 200/120 mmHg, however there are no universally accepted cutoff values.

The Dietary Approaches to Stop Hypertension or the DASH diet is a diet to control hypertension promoted by the U.S.-based National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH), an agency of the United States Department of Health and Human Services. The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods. It includes meat, fish, poultry, nuts, and beans, and is limited in sugar-sweetened foods and beverages, red meat, and added fats. In addition to its effect on blood pressure, it is designed to be a well-balanced approach to eating for the general public. DASH is recommended by the United States Department of Agriculture (USDA) as a healthy eating plan. The DASH diet is one of three healthy diets recommended in the 2015–20 U.S. Dietary Guidelines, which also include the Mediterranean diet and a vegetarian diet. The American Heart Association (AHA) considers the DASH diet "specific and well-documented across age, sex and ethnically diverse groups."

Prehypertension, also known as high normal blood pressure and borderline hypertensive (BH), is a medical classification for cases where a person's blood pressure is elevated above optimal or normal, but not to the level considered hypertension. Prehypertension is now referred to as "elevated blood pressure" by the American College of Cardiology (ACC) and the American Heart Association (AHA). The ACC/AHA define elevated blood pressure as readings with a systolic pressure from 120 to 129 mm Hg and a diastolic pressure under 80 mm Hg, Readings greater than or equal to 130/80 mm Hg are considered hypertension by ACC/AHA and if greater than or equal to 140/90 mm Hg by ESC/ESH. and the European Society of Hypertension defines "high normal blood pressure" as readings with a systolic pressure from 130 to 139 mm Hg and a diastolic pressure 85-89 mm Hg.

A low sodium diet is a diet that includes no more than 1,500 to 2,400 mg of sodium per day.

Orthostatic hypertension is a medical condition consisting of a sudden and abrupt increase in blood pressure (BP) when a person stands up. Orthostatic hypertension is diagnosed by a rise in systolic BP of 20 mmHg or more when standing. Orthostatic diastolic hypertension is a condition in which the diastolic BP raises to 98 mmHg or over in response to standing, but this definition currently lacks clear medical consensus, so is subject to change. Orthostatic hypertension involving the systolic BP is known as systolic orthostatic hypertension.

<span class="mw-page-title-main">Heart failure with preserved ejection fraction</span> Medical condition

Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; this may be measured by echocardiography or cardiac catheterization. Approximately half of people with heart failure have preserved ejection fraction, while the other half have a reduction in ejection fraction, called heart failure with reduced ejection fraction (HFrEF).

Hypertensive disease of pregnancy, also known as maternal hypertensive disorder, is a group of high blood pressure disorders that include preeclampsia, preeclampsia superimposed on chronic hypertension, gestational hypertension, and chronic hypertension.

Hypertension is managed using lifestyle modification and antihypertensive medications. Hypertension is usually treated to achieve a blood pressure of below 140/90 mmHg to 160/100 mmHg. According to one 2003 review, reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21% and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease.

The Systolic Blood Pressure Intervention Trial (SPRINT) is a multi-center clinical trial that was performed from 2010 to 2015, and published in November 2015.

References

  1. ↑ Angeli F, Verdecchia P, Masnaghetti S, Vaudo G, Reboldi G (October 2020). "Treatment strategies for isolated systolic hypertension in elderly patients". Expert Opinion on Pharmacotherapy. 21 (14): 1713–1723. doi:10.1080/14656566.2020.1781092. PMID   32584617. S2CID   220078261.
  2. ↑ "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.
  3. ↑ Angeli F, Verdecchia P, Masnaghetti S, Vaudo G, Reboldi G (October 2020). "Treatment strategies for isolated systolic hypertension in elderly patients". Expert Opinion on Pharmacotherapy. 21 (14): 1713–1723. doi:10.1080/14656566.2020.1781092. PMID   32584617. S2CID   220078261.
  4. ↑ Smulyan H, Safar ME (February 2000). "The diastolic blood pressure in systolic hypertension". Annals of Internal Medicine. 132 (3): 233–237. doi:10.7326/0003-4819-132-3-200002010-00010. PMID   10651605. S2CID   12914966.
  5. 1 2 DeLoach SS, Townsend RR (March 2008). "Systolic Hypertension: A Guide to Optimal Therapy". Consultant. 48 (3). Archived from the original on 2013-01-19.
  6. ↑ Reymond P, Westerhof N, Stergiopulos N (March 2012). "Systolic hypertension mechanisms: effect of global and local proximal aorta stiffening on pulse pressure". Annals of Biomedical Engineering. 40 (3): 742–749. doi:10.1007/s10439-011-0443-x. PMID   22016326. S2CID   254185822.
  7. ↑ Bergler-Klein J (April 2019). "What's new in the ESC 2018 guidelines for arterial hypertension : The ten most important messages". Wiener Klinische Wochenschrift. 131 (7–8): 180–185. doi:10.1007/s00508-018-1435-8. PMC   6459798 . PMID   30715608.
  8. ↑ Musini VM, Tejani AM, Bassett K, Puil L, Wright JM (June 2019). "Pharmacotherapy for hypertension in adults 60 years or older". The Cochrane Database of Systematic Reviews. 6 (6): CD000028. doi:10.1002/14651858.CD000028.pub3. PMC   6550717 . PMID   31167038.
  9. ↑ Musini VM, Gueyffier F, Puil L, Salzwedel DM, Wright JM (August 2017). "Pharmacotherapy for hypertension in adults aged 18 to 59 years". The Cochrane Database of Systematic Reviews. 2017 (8): CD008276. doi:10.1002/14651858.CD008276.pub2. PMC   6483466 . PMID   28813123.
  10. ↑ Egan BM, Yang J, Rakotz MK, Sutherland SE, Jamerson KA, Wright JT, et al. (February 2022). "Self-Reported Antihypertensive Medication Class and Temporal Relationship to Treatment Guidelines". Hypertension. 79 (2): 338–348. doi: 10.1161/HYPERTENSIONAHA.121.17102 . PMID   34784722. S2CID   244375750.
  11. ↑ Commodore-Mensah Y, Loustalot F, Himmelfarb CD, Desvigne-Nickens P, Sachdev V, Bibbins-Domingo K, et al. (March 2022). "Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension". American Journal of Hypertension. 35 (3): 232–243. doi:10.1093/ajh/hpab182. PMC   8903890 . PMID   35259237.
  12. ↑ Somes GW, Pahor M, Shorr RI, Cushman WC, Applegate WB (September 1999). "The role of diastolic blood pressure when treating isolated systolic hypertension". Archives of Internal Medicine. 159 (17): 2004–2009. doi: 10.1001/archinte.159.17.2004 . PMID   10510985.
  13. 1 2 Boutitie F, Gueyffier F, Pocock S, Fagard R, Boissel JP (March 2002). "J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data". Annals of Internal Medicine. 136 (6): 438–448. doi:10.7326/0003-4819-136-6-200203190-00007. PMID   11900496. S2CID   38738695.
  14. ↑ Hypertension Detection and Follow-up Program Cooperative Group (December 1979). "Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension". JAMA. 242 (23): 2562–2571. doi:10.1001/jama.242.23.2562. PMID   490882.
  15. ↑ "MRC trial of treatment of mild hypertension: principal results. Medical Research Council Working Party". British Medical Journal. 291 (6488): 97–104. July 1985. doi:10.1136/bmj.291.6488.97. PMC   1416260 . PMID   2861880.
  16. 1 2 Arguedas, Jose Agustin; Leiva, Viriam; Wright, James M. (2020-12-17). "Blood pressure targets in adults with hypertension". The Cochrane Database of Systematic Reviews. 2020 (12): CD004349. doi:10.1002/14651858.CD004349.pub3. ISSN   1469-493X. PMC   8094587 . PMID   33332584.
  17. ↑ Koracevic G, Stojanovic M, Kostic T, Lovic D, Tomasevic M, Jankovic-Tomasevic R (2020). "Unsolved Problem: (Isolated) Systolic Hypertension with Diastolic Blood Pressure below the Safety Margin". Medical Principles and Practice. 29 (4): 301–309. doi:10.1159/000508462. PMC   7445659 . PMID   32380500.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.