Increasing arterial stiffness associated with age is what leads to a rise in systolic blood pressure and the development of isolated systolic hypertension, consequently leading to heart failure and other cardiovascular events. Secondary causes of isolated systolic hypertension include anemia, aortic insufficiency, Paget’s disease, beriberi, and hyperthyroidism, all of which increase cardiac output.
While JNC 8 does not discriminate among ACE inhibitors, calcium channel blockers, or diuretics as initial treatment options for this population, the ESH/ESC guideline recommends a calcium channel blocker or diuretic. Given the age of this population and current studies on this population, a long-acting dihydropyridine calcium channel blocker such as amlodipine is recommended as the initial agent, followed by an ACE inhibitor (Lisinopril) or low-dose thiazide diuretic (chlorthalidone) if necessary.
On Hypertension in the Elderly: An Epidemiologic Shift. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2015/02/19/14/55/on-hypertension-in-the-elderly. Accessed February 21, 2017.Expert Review of Cardiovascular Therapy. Treatment of Isolated systolic hypertension in the elderly: Expert Review of Cardiovascular Therapy: Vol 10, No 11. http://www.tandfonline.com/doi/abs/10.1586/erc.12.117?journalCode=ierk20. Accessed February 21, 2017.
Blood pressure. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets: Blood Pressure: Vol 25, No 6.http://www.tandfonline.com/doi/abs/10.1080/08037051.2016.1236329?journalCode=iblo20. Accessed February 21, 2017.
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Posted by Christine Choe, PharmD Candidate 2018