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Abstract
Isolated systolic hypertension, an elevation in systolic but not diastolic pressure,
is the most prevalent type of hypertension in those aged 50 or over, occurring either
de novo or as a development after a long period of systolic-diastolic hypertension
with or without treatment. The increase in blood pressure with age is mostly associated
with structural changes in the arteries and especially with large artery stiffness.
It is known from various studies that rising blood pressure is associated with increased
cardiovascular risk. In the elderly, the most powerful predictor of risk is increased
pulse pressure due to decreased diastolic and increased systolic blood pressure. All
evidence indicates that treating the elderly hypertensive patient will reduce the
risk of cardiovascular events. However, there is no evidence yet for the very elderly.
This population is particularly susceptible to side effects of treatments and the
reduction of blood pressure, although reducing the risk of cardiovascular events such
as stroke, may result in increased mortality.