Isolated systolic hypertension in the elderly

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Abstract
Isolated systolic hypertension occurs principally in persons over 60 years of age, with its prevalence increasing from approximately 15% to twice that at age 75 years and over. The proportion of the U.S. population overage 60 years is also rising and is predicted to increase by nearly 40% by the end of the century. Excess cardiovascular risk, especially for stroke, is strongly associated with elevated systolic pressure. Isolated systolic hypertension is the most important unresolved issue in the management of high blood pressure. The importance of this issue is compounded by the fact that considerable uncertainty exists as to the risks and benefits of treatment. A pilot study to assess the feasibility of carrying out a full-scale trial of isolated systolic hypertension in the elderly is currently being undertaken. The selection and evaluation procedures to recruit at least 500 subjects and the randomized, double-blind stepped-care treatment programme to be followed in this long-term trial are described and discussed.