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Systolic Hypertension Print E-mail

Dr. Kennedy Systolic blood pressure is the maximum pressure developed in the arterial system when the heart is contracting ("in systoly"). Systolic hypertension is defined as an elevated systolic blood pressure. If systolic blood pressure is elevated with a normal diastolic blood pressure, it is called isolated systolic hypertension. Systolic hypertension may be due to reduced compliance of the aorta with increasing age.

Two randomized controlled trials have established the value of treating systolic hypertension. The SHEP study showed a reduction of three strokes per 100 patients treated for five years with chlorthalidone. Inclusion criteria were SBP (systolic blood pressure) greater than 160 to 219 mm Hg and DBP (diatolic blood pressure) less than 90 mm Hg. Mean initial BP was 170/77. The treatment goal was a reduction of 20 mm Hg in systolic pressure or a systolic pressure of less than 160 mm Hg, whichever was lower. The mean final blood pressure in the treatment group was 143/68. The Syst-Eur Trial showed a reduction of 0.3 strokes per 100 patients treated with nitrendipine for a median follow-up of two years. Inclusion criteria were systolic of 160-219 mm Hg and diastolic blood pressure lower than 95 mm Hg. Average was 174/86. 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. Corroborating this, a re-analysis of the SHEP data suggest that allowing the diastolic to go below 70 may increase adverse effects.

References:

SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP) JAMA. 1991;265:3255-64.

Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators Lancet. 1997;350:757-64.



The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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