LAUSR

See related article, pp 220–227 As our aging population grows, more and more patients with hypertension have isolated systolic hypertension (ISH). In the United States, 60% of older patients with hypertension have this form of hypertension.1 This disorder has generally been defined by a systolic blood pressure (SBP) >140 mm Hg and a diastolic blood pressure (BP) <90 mm Hg.2 The understanding of the rise in BP with age has changed dramatically over the last few decades. In the early years of hypertension treatment, there was no evidence to direct decision-making regarding treatment of those with ISH. Because SBP rose with age in essentially every industrialized country around the world, the assumption was made that this elevation was a natural part of the aging process. It was commonly accepted that the rise in BP with age was necessary to achieve appropriate organ perfusion as arteries stiffened. A common management plan was to accept an SBP of 100 mm Hg+the age of the patient. Thus, an acceptable SBP in an 80-year-old patient was considered to be 180 mm Hg. As our understanding of the distinction between normal aging and the impact of atherosclerosis on blood vessels became clearer, researchers and clinicians began questioning the approach of accepting high levels of SBP in the elderly. This questioning led to a series of clinical trials primarily addressing the question of whether reducing SBP in patients with ISH was safe or effective. From 1991 to 2008, 5 …