What is the best drug for isolated systolic hypertension?
Pharmacotherapy: Ideal agents would target those pathophysiologic derangements that are thought to be present in ISH, and without causing serious side effects. In particular, the emergence of widened pulse pressure as a significant independent risk factor for mortality highlights the importance of avoiding agents whose actions might increase the pulse pressure?for example, agents that cause profound decreases in diastolic blood pressure. For ISH, then, a theoretic advantage would be seen in agents having a direct vasodilatory effect on the aorta and large vessels, improving arterial compliance and reversing the changes that are seen with aging and ISH. Diuretics Diuretics remain first-line agents in the treatment of ISH in the elderly since the impressive results of the SHEP trial,11 with good control often seen at relatively low doses of agent. A review of a series of smaller studies suggests that thiazide diuretics may be superior to beta blockers in patients with ISH.22 Calcium Chan
