Isolated systolic hypertension
is characterized by a widened pulse pressure. It has been recognized as an important entity, which requires consistent treatment. Apart from the well‐known advices for life‐style modification, drug treatment is required in the majority of patients with ISH.
The data so far available indicate that low‐dose thiazide diuretics and slow/long‐acting calcium antagonists are the drugs of first choice. A slow reduction of systolic pressure in the mostly elderly patients is mandatory. A target level of SBP around 140 mmHg seems desirable. Drugs which can be used are
, an aldosterone
antagonist, is not only a (rather weak) natriuretic agent. It also inhibits the synthesis of collagen and myocardial and vascular fibrosis
provoked by aldosterone. For this reason spironolactone may counteract the arterial stiffness
which underlies the pathogenesis of ISH. Studies have indeed documented favourable effects of spironolactone in ISH patients.
is a newer aldosterone antagonist with much weaker endocrine activities than spironolactone, so that one would expect fewer endocrine side‐effects such as gynaecomastia;
(iii) Nitrates, as NO generators, may also be considered as a potential new approach in the treatment of ISH. Isosorbide dinitrate
has been shown to selectively lower systolic blood pressure without changing diastolic pressure in elderly patients with isolated systolic hypertension. It took 8 weeks of treatment before the effect on systolic blood pressure became manifest.
Consult your doctor for their use.