Effects in Hypertension

Isolated systolic hypertension in the elderly has been related to the age-induced increase in aortic stiffness. Although the benefits of calcium channel blockers and diuretics have been demonstrated in this disease [28, 29], clinical experience has shown that it is often difficult to lower the brachial artery SBP to the therapeutic target without using uncomfortably large doses. These doses may also induce excessive reductions in diastolic pressures that relate to total and cardiovascular mortality [ 30]. Greater decreases in diastolic blood pressure than in SBP stress the importance of pulse pressure during therapy as a risk factor. Although organic nitrates may not be able to combat the aortic stiffness of aging, they have a vasorelaxing effect on the peripheral arteries and ameliorate the deleterious effects of strong reflected waves into the aorta. Several small observational studies support this possibility as clinically useful [3133]. Although the use of nitrates in patients with isolated systolic hypertension whose SBPs are difficult to control seems reasonable, there are no large randomized, controlled trials to support it. Nitrate tolerance could be a problem, but oral administration, once or twice daily, or even 12-hourly nitrate patches might ameliorate this problem. At present, isosorbide might be added with benefit to a conventional regimen in those patients with isolated systolic hypertension who are difficult to treat.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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