Systolic Hypertension: An Updated Review for Healthcare Professionals

Abstract

Background: Isolated systolic hypertension (ISH) is the most prevalent form of hypertension in older adults, defined by systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) <90 mmHg. The 2017 ACC/AHA guidelines redefined hypertension as SBP ≥130 mmHg, expanding the at-risk population. ISH is driven by arterial stiffening and poses significant risks for stroke, myocardial infarction, and renal dysfunction.

Aim: This review synthesizes current evidence on ISH pathophysiology, diagnosis, and management to guide healthcare professionals in optimizing patient outcomes.

Methods: A comprehensive analysis of clinical guidelines (ACC/AHA), landmark trials (HYVET, SHEP, SPRINT), and epidemiological studies (NHANES, Framingham) was conducted. Emphasis was placed on etiology, diagnostic approaches (including ambulatory monitoring to differentiate white-coat/masked hypertension), and evidence-based treatment strategies.

Results: ISH affects 30% of adults >60 years, with higher prevalence in women and non-Hispanic Black individuals. Pathophysiology centers on age-related vascular calcification and collagen deposition, leading to elevated pulse wave velocity. First-line therapies include thiazide diuretics and calcium channel blockers, with SBP targets <130 mmHg for most patients (or <140/90 mmHg in frail elderly). Nonpharmacologic interventions (DASH diet, sodium restriction, exercise) reduce SBP by 4–12 mmHg. The J-curve phenomenon cautions against excessive DBP reduction (<70 mmHg) in coronary artery disease.

Conclusion: ISH management requires individualized strategies balancing efficacy and safety, particularly in older adults. Interprofessional care models improve adherence and outcomes.