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Isolated systolic hypertension

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • drug therapy should be started in all patients with sustained systolic blood pressures >= 160 mmHg despite non-pharmacologic measures (1,2)
  • isolated hypertension (>=160/<90 mmHg) occurs in more than 50% of patients over 60 years old. Isolated systolic hypertension and wide pulse pressure in elderly people increase the risk of mortality and morbidity (2). Treatment leads to a reduction in risk (2,3,4,5)
    • in the SHEP trial, treatment of isolated systolic hypertension with chlorthalidone stepped-care therapy for 4.5 years was associated with longer life expectancy at 22 years of follow-up (6)
  • there is no firm evidence to guide the management of borderline isolated hypertension (systolic blood pressure 140-159mmHg and diastolic blood pressures <90 mmHg)

  • NICE state that patients with isolated systolic hypertension (systolic BP 160 mmHg or more) should be offered the same treatment as patients with both raised systolic and diastolic blood pressure (1)
    • the guidance also notes that patients with isolated systolic hypertension received similar benefits from treatment to other patients with raised blood pressure


  1. NICE (November 2019). Management of hypertension in adults in primary care.
  2. Ramsey LE et al (1999). Guidelines for the management of hypertension: report of the third working party of the British Hypertension Society, 1999. J Hum Hypertens, 13, 569-92.
  3. Staessen JA, Gasowski J, Wang JG et al (2000). Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet, 355, 865-72.
  4. Ferrucci L et al. (2001). Treatment of isolated systolic hypertension is most effective in older patients with high-risk profile. Circulation, 104, 1923-6.
  5. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991;265, 3255-3264.
  6. Kostis JB et al. Association between chlorthalidone treatment of systolic hypertension and long-term survival. JAMA. 2011 Dec 21;306(23):2588-93.

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