medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

, systolic hypertension is defined as an elevated

systolic blood pressure 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" r ...

(SBP). If the systolic blood pressure is elevated (>140) with a normal (<90) diastolic blood pressure (DBP), it is called isolated systolic hypertension. Eighty percent of people with systolic hypertension are over the age of 65 years old.

Causes

Systolic hypertension may be due to reduced compliance of the

aorta The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes ...

with increasing age. This increases the load on the ventricle and compromises coronary blood flow, eventually resulting in

left ventricular hypertrophy Left ventricular hypertrophy (LVH) is thickening of the heart muscle of the left ventricle of the heart, that is, left-sided ventricular hypertrophy and resulting increased left ventricular mass. Causes While ventricular hypertrophy occurs na ...

coronary ischemia Coronary ischemia, myocardial ischemia, or cardiac ischemia,Potochny, Evy. "Cardiac Ischemia Symptoms." LiveStrong. Demand Media, 9 March 2010. Web. 6 Nov. 2010. is a medical term for a reduced blood flow in the coronary circulation through the c ...

, and

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...

. Contemporary science shows an

immersed boundary method In computational fluid dynamics, the immersed boundary method originally referred to an approach developed by Charles Peskin in 1972 to simulate fluid-structure (fiber) interactions. Treating the coupling of the structure deformations and the flui ...

of computational illustration of a single heartbeat. Applied to physiologic models, immersed boundary theory sees the heart as a great folded semisolid

sail A sail is a tensile structure—which is made from fabric or other membrane materials—that uses wind power to propel sailing craft, including sailing ships, sailboats, windsurfers, ice boats, and even sail-powered land vehicles. Sails may ...

fielding and retrieving a viscous blood mass. The sail, likened to

Windkessel effect Windkessel effect is a term used in medicine to account for the shape of the arterial blood pressure waveform in terms of the interaction between the stroke volume and the compliance of the aorta and large elastic arteries (Windkessel vessels) an ...

physiology, gives and receives a load under time-ordered phases. Decreasing compliance of the sail heralds the onset of systolic hypertension.

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 Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other conn ...

, increased physical activity, and limiting alcohol consumption. 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). In addition to lifestyle changes, medication can also be used to reduce systolic hypertension to safe levels. Common medications used to treat systolic hypertension include a thiazide-type diuretic (TTD) or calcium channel blockers (CCB), or a combination of the two.

Goal

Based on these studies, treating to a

of 140, as long as the

diastolic blood pressure 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" r ...

is 68 or more, seems safe. Corroborating this, a reanalysis of the SHEP data suggests allowing the diastolic to go below 70 may increase adverse effects. A

meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...

of individual patient data from

randomized controlled trial A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical te ...

s found the lowest

for which cardiovascular outcomes improve is 85 mm Hg for untreated hypertensives and 80 mm Hg for treated hypertensives. The authors concluded "poor health conditions leading to low blood pressure and an increased risk for death probably explain the J-shaped curve". Interpreting the meta-analysis is difficult, but avoiding a diastolic blood pressure below 68–70 mm Hg seems reasonable because: * 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) and Medical Research Council trial in mild hypertension (MRC1) 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. Further research is needed, the results of this review were applicable mainly to older individuals with moderate to high cardiovascular risk. 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%

References

{{Vascular diseases Hypertension