Isolated systolic hypertension

Associated with elevated cardiac output of anemia, hyperthyroidism, aortic insufficiency, arteriovenous fistula, and Paget’s disease of the bone.

Most cases caused by decreased elasticity and compliance of large arteries resulting from the atherosclerosis associated accumulation of calcium and collagen and degeneration of arterial elastin.

Arterial stiffness causes an increase in the rate of return of reflected arterial pressure waves, raising peak systolic pressure.

Promotes arterial stiffening and impairs vasodilation related to the endothelium.

Initial evaluation includes assessment for other cardiovascular risk factors, end-organ damage analysis, assessment of concomitant diseases, identifying causes of hypertension, identifying lifestyle factors contributing to the process.

Physical examination includes assessment of the thyroid, heart, lungs, fundi, kidneys, pulses and neurologic system.

Standard blood pressure measurement with a blood pressure cuff may overestimate arterial pressure because of incomplete compression of the brachial artery, and is known as pseudohypertension.

Routine laboratory evaluation includes electrocardiography, urinalysis, complete blood count, chemistry profile, lipid analysis, glomerular filtration rate and thyroid function tests.

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