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Item
#12
Systolic Blood Pressure is the
Most Important Marker of Cardiovascular Complications in the
Elderly
Therefore,
the need for more strict control of this component of blood
pressure must be reconsidered
In the
early stage of hypertension, diastolic blood pressure has greater
prognostic importance, but in the elderly, systolic blood pressure
is the most important marker of cardiovascular complications.
Therefore, the need for more strict control of this component of
blood pressure must be reconsidered.
The
benefit obtained in different studies in the elderly suggests that
the treatment of isolated systolic hypertension is associated with
a reduction in overall cardiovascular mortality of 22%, in
coronary heart disease mortality of 26%, and in stroke mortality
of 33%. However, a higher percentage of patients (73%) attain the
diastolic goal of <90 mm Hg, while only 34% have systolic pressure
reduced to <140 mm Hg.
In a
review of randomized trials comparing at least four different
antihypertensive drugs, significant differences in systolic blood
pressure reduction have not been demonstrated, except in black
populations, in whom calcium channel blockers and diuretics seem
to be more effective. In patients with isolated systolic
hypertension, data are inconclusive, but calcium channel blockers
and diuretics appear to lower blood pressure to a greater degree
than do other antihypertensive drugs.
Two main
predictors of difficulty in controlling systolic blood pressure
are the baseline blood pressure and the presence of diabetes.
Other predictors are the duration of arterial hypertension, older
age, the presence of target organ damage and associated clinical
conditions (myocardial infarction, stroke, chronic renal failure),
and an elevated serum uric acid level. It appears that the profile
of patients with a poorer therapeutic response includes a greater
severity of hypertension and/or the presence of cardiovascular
disease.
As recently published guidelines suggest, patients at high
cardiovascular risk should be treated early and with combined
therapy, in an attempt to counteract the different components that
elevate BP and lead to cardiovascular damage. At present, there is
no specific test to determine which drug is best for an individual
patient; hence the need for multiple medications. In high-risk
patients we need to assure strict control of both BP and other
cardiovascular risk factors.
J Clin
Hypertens. 2002;4:35-40
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