Isolated Systolic Hypertension from a Vascular Point of View

Abstract

Due to the results of antihypertensive intervention studies, isolated systolic hypertension (ISH) has gained new interest lately. Yet, apart from increased aortic stiffness, the specific pathophysiological features of ISH have remained largely undetermined. Therefore, we investigated the elastic properties of the vascular bed of an upper arm segment in uncomplicated ISH patients and matched normotensive controls using an electrical bioimpedance technique. Compared with the controls, the compliance of the arterial bed as a whole at normotensive blood pressure level was on the average 108.0% higher (p < 0.005) in the hypertensive patients. The blood volume of the arterial bed as a whole at operating blood pressure level and that of the larger arteries were significantly higher (40.5%, p < 0.05, and 40.5%, p < 0.01, respectively). The same held true for the venous blood volume (64.4%, p < 0.05), and for the width of the arterial compliance-pressure relation (34.6%, p < 0.01). We concluded that ISH is a separate pathophysiological entity in which all parts of a peripheral vascular bed are changed and the decreased buffering function of the aorta and large arteries is partly compensated for by an increase in small artery compliance.

Assessment of thoracic aortic elasticity: a preliminary study using electrocardiographically gated dual-source CT

“…Therefore, the decline in endothelial NO production with age may underlie some age-related arterial stiffening. Also, isolated systolic hypertension is a 'natural' consequence of aging, it is associated with increased aortic stiffness and is now recognised as a major risk factor for cardiovascular diseases [27]. In addition to age, all of these changes may play a complex role in the decrease of aortic elasticity especially for older patients, therefore the proportion of influence of age declined in the statistical analysis.…”

Evaluation of mechanical arterial properties: clinical, experimental and therapeutic aspects

“…The situation becomes even more complex when one considers that high blood pressure frequently co-exists with other cardiovascular risk factors that may independently alter the structure and tone of arterial blood vessels [96,97]. A recent study [146] also indicates that the mechanical properties of arteries may differ in patients with isolated systolic hypertension in comparison with systo-diastolic hypertension.…”

Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor?

“…Data from clinical studies indicate that ISH is a distinct syndrome with pathophysiological changes different from those in essential hypertension [23]. The main feature of ISH is a decreased distensibility of the aorta and large arteries with subsequent cardiovascular events [24,25].…”

“…Framingham heart study has also demonstrated an increase in arterial stiffness due to aging or pathology and a decrease in arterial distensibility [27]. Though other studies have questioned the reduction in distensibility as a natural consequence of aging [23,28], the recent Framin-gham offspring study involved healthy individuals demonstrated age-related increase in aortic stiffness with little change in peripheral arteries [29]. It is not known whether the decreased distensibility or the elevation of systolic blood pressure occur first.…”