ABSTRACT
For many years, the incidence of systolic hypertension has been increasing in the elderly.
The reasons for this evolution are quite simple (1). First, prolongation of life is responsible
for an increased number of older individuals with increased systolic blood pressure (SBP).
Second, the goal of treatment in middle-aged subjects with systolic-diastolic hypertension
was based in the past on reduction of diastolic blood pressure (DBP). Because it is much
easier to control DBP (!90 mmHg) than SBP (!140 mmHg) (2) by drug treatment, and
because, with age, DBP tends spontaneously to decrease and SBP to increase, this
evolution contributes per se to enhance the incidence of systolic hypertension (3). All
these findings are quite important to consider for two reasons. First, the pathophysiological
mechanisms of systolic hypertension involve, in addition to altered vascular resistance,
which is the classical hallmark of hypertension, consistent changes in arterial stiffness and
wave reflections, which refer to conduit arteries (mainly the aorta and its principal
branches) (1,4). Second, from the different varieties of hypertension in humans, the most
sensitive to sodium is hypertension in the elderly (5-7).
