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Strong evidence for treatment of systolic hypertension in older patients with SBP of at least 160 mm Hg

A review of the medical literature suggests that older persons with systolic hypertension (and systolic blood pressure of at least 160 mm Hg ) should receive treatment.

Systolic hypertension ( SH ), defined as systolic blood pressure ( SBP ) of at least 140 mm Hg and diastolic blood pressure ( DBP ) of less than 90 mm Hg, is a major public health issue that predominantly affects older individuals.

According to Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure ( JNC7 ), systolic hypertension, in older persons ( those aged 60 years and older ), is a much more important cardiovascular disease risk factor than diastolic hypertension, and consequently, the control of SBP should be the focus of treatment in this population.

Despite this recommendation, poor control of SH is increasing.

A recent study examining trends in hypertension control found that isolated elevation of SBP was the most common finding among patients being treated for hypertension, occurring in 76% of patients in 1999 compared with 57% in 1990-1995.

West Haven Veterans Affairs Medical Center researchers and colleagues examined the evidence on the clinical management of SH in older persons by reviewing previous studies.

In analyzing the studies, the researchers found that there is strong evidence from clinical trials to support the treatment of SH in older persons with SBP of at least 160 mm Hg.

Large-scale trials to assess the value of antihypertensive therapy for older patients with SBP of 140 to 159 mm Hg have not been performed, and recommendations to treat these patients are based on observational studies that show a graded relationship of cardiovascular risk with increasing SBP.
The studies most strongly support the use of thiazide diuretics and long-acting calcium channel blockers as first-line therapy to treat SH.

Sarwat I et al, JAMA 2004;292:1074-1080