Clinical studies and therapeutic trials in systolic hypertension

A disproportionate increase in SEP over DBP has been recognized for many ye ars as a frequent accompaniment of aging. Initially this was considered to be benign, risk free and potentially dangerous to treat. Study over the yea rs has shown that it is not benign and that antihypertensive therapy can re duce the risks of stroke, myocardial infarction, congestive heart failure a nd cardiovascular death. Currently, the drugs most widely recommended for t his purpose are the thiazide diuretics, long acting dihydropiridine calcium channel antagonists, ACE inhibitors, and beta blocking agents. There may b e a special place for nitrates, since these agents are very effective in in creasing arterial distensibility - a primary abnormality of the disorder bu t a formal study of their effectiveness has not been done. Concern about di astolic hypotension during therapy suggests that treatment to lower the blo od pressure in this disorder should be carried out gradually with the aim o f reducing the SEP toward normal while avoiding diastolic hypotension.