Treatment strategies for isolated systolic hypertension in elderly patients

Fabio Angeli, Paolo Verdecchia, Sergio Masnaghetti, Gaetano Vaudo, Gianpaolo Reboldi

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Hypertension is a major and modifiable risk factor for cardiovascular disease. Its prevalence is rising as the result of population aging. Isolated systolic hypertension mostly occurs in older patients accounting for up to 80% of cases.

AREAS COVERED: The authors systematically review published studies to appraise the scientific and clinical evidence supporting the role of blood pressure control in elderly patients with isolated systolic hypertension, and to assess the influence of different drug treatment regimens on outcomes.

EXPERT OPINION: Antihypertensive treatment of isolated systolic hypertension significantly reduces the risk of morbidity and mortality in elderly patients. Thiazide diuretics and dihydropyridine calcium-channel blockers are the primary compounds used in randomized clinical trials. These drugs can be considered as first-line agents for the management of isolated systolic hypertension. Free or fixed combination therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and calcium-channel blockers or thiazide-like diuretics should also be considered, particularly when compelling indications such as coronary artery disease, chronic kidney disease, diabetes, and congestive heart failure coexist. There is also hot scientific debate on the optimal blood pressure target to be achieved in elderly patients with isolated systolic hypertension, but current recommendations are scarcely supported by evidence.

Original languageEnglish
Pages (from-to)1713-1723
Number of pages11
JournalExpert Opinion on Pharmacotherapy
Issue number14
Publication statusPublished - Oct 2020


  • Aged
  • Angiotensin Receptor Antagonists/administration & dosage
  • Angiotensin-Converting Enzyme Inhibitors/administration & dosage
  • Antihypertensive Agents/administration & dosage
  • Blood Pressure/drug effects
  • Calcium Channel Blockers/administration & dosage
  • Diabetes Mellitus/drug therapy
  • Drug Therapy, Combination
  • Humans
  • Hypertension/drug therapy
  • Sodium Chloride Symporter Inhibitors/administration & dosage


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