Resumen de The pathobiology of isolated systolic hypertension
Central artery stiffening with aging is the driving force that results in increased pulse pressure (PP) and ultimately the development of isolated systolic hypertension (ISH). Since diastolic blood pressure (DBP) rises with increased small arterial and arteriolar resistance and falls with increased large artery stiffness, DBP displays a J-curve pattern of CV risk; thus, PP is a stronger risk factor than systolic blood pressure (SBP) in patients with ISH when DBP is <70mmHg. ISH can develop from either �burned-out� diastolic hypertension or de novo, secondary to increased arterial stiffness without going through a preliminary phase of essential hypertension. De novo ISH, the most frequent form of ISH, has multiple etiologies, which include a variety of conditions that impair synthesis of elastin protein and increase large artery calcification. The projected increase in ISH with aging of the US population and the often found resistance of ISH to antihypertensive therapy represent a potential worsening public health problem.
