Systolic hypertension: A guide to optimal therapy

Systolic hypertension is an independent risk factor for coronary artery disease, stroke, and end-stage renal disease. Nonpharmacological interventions for systolic hypertension include limitation of dietary sodium and alcohol intake along with weight reduction and aerobic exercise. Thiazide diuretics are first-line therapy for hypertension, especially when the goal is reduction of systolic blood pressure. Angiotensin-Converting enzyme inhibitors and angiotensin receptor blockers may delay or prevent the onset of diabetes. Calcium channel blockers effectively treat systolic hypertension and may be preferable in patients who require rate control or who have comorbid conditions such as Raynaud disease or migraine. Causes of refractory hypertension include renovascular disease, aldosteronism, pheochromocytoma, and thyroid dysfunction.