LAUSR

This editorial refers to ‘Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry’, by F. Mahfoud et al. doi:10.1093/eurheartj/ehw325. According to current ESH/ESC Guidelines for the management of hypertension, isolated systolic hypertension (ISH) is defined as office systolic blood pressure (BP) ≥140 mmHg and diastolic BP < 90 mmHg.1 The prevalence of this form of hypertension increases with age, being the most prevalent form of hypertension in those aged over 50 years.2 Indeed an age-related decline in diastolic BP and an increase in systolic BP is physiological even in normotensive individuals, due to large artery stiffening. Repetitive stretch of elastic lamellae in the vascular wall of the aorta and its main branches causes their rupture over years, inducing dilation and stiffness. The consequent loss of the reservoir function of the aorta and early wave reflection are responsible for the physiological behaviour of BP with ageing,3 characterized by wide pulse pressure (PP) and ultimately ISH ( Figure 1 ). For that reason, PP is accepted as a simple, widely available measure of aortic stiffness, although other factors, such as aortic flow and aortic diameter, also play a major role. …