Systolic hypertension: an increasing clinical challenge in Asia

Abstract

Systolic hypertension, the predominant form of hypertension in patients aged over 50-60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications.

Figure 1

The higher risk of (a) fatal and nonfatal coronary heart disease and (b) stroke, associated with higher systolic blood pressure levels by age and region in the Asia Pacific Cohort Studies Collaboration. SBP, systolic blood pressure. Reprinted with permission from Perkovic et al.

Figure 2

Systolic blood pressure increases with age in Asian patients. ANZ, Australia and New Zealand; SBP, systolic blood pressure. Reprinted with permission from Asia Pacific Cohort Studies Collaboration.

Figure 3

Diastolic hypertension becomes less prevalent with increasing patient age. IDH, isolated diastolic hypertension; ISH, isolated systolic hypertension; SDH, systolic-diastolic hypertension. Reprinted with permission from Macmillan Publishers: Journal of Human Hypertension.

Figure 4

There is a linear association between usual SBP and ischemic stroke, hemorrhagic stroke and other strokes in the Asia-Pacific region. SBP, systolic blood pressure. Adapted with permission from Lippincott Williams and Wilkins/Wolters Kluwer Health: Stroke.

Figure 5

Antihypertensive treatment significantly reduces fatal and nonfatal outcomes in Asian patients with hypertension: the Syst-China trial. CV; cardiovascular; Syst-China, Systolic Hypertension in China.