Although systolic hypertension in the elderly has received limited attention, it is associated with increased mortality and morbidity; it is not clear, however, whether it is the elevated blood pressure or the arteriosclerosis, for which it is a marker, that increases the risk. While there are no controlled, prospective trials confirming a reduction in morbidity and mortality with treatment, reduction of the systolic blood pressure will reduce the left ventricular work load, and in my opinion is indicated when the diagnosis of systolic hypertension is clearly established by multiple determinations. Contrary to the opinion of some, the elderly are able to tolerate antihypertensive drugs well when the drugs are administered cautiously in low dosages initially, with small increments.
Gifford RW. Isolated Systolic Hypertension in the Elderly: Some Controversial Issues. JAMA. 1982;247(6):781–785. doi:10.1001/jama.1982.03320310029023
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