Isolated systolic hypertension, pulse pressure, and arterial stiffness as risk factors for cardiovascular disease.

Arterial stiffening with age is responsible for isolated systolic hypertension, for elevation of systolic pressure with age, and for the majority of cardiovascular events in the elderly, especially left ventricular failure. Change in brachial pulse pressure with age underestimates change in aortic pulse pressure; change with vasodilator agents, especially nitrates, underestimates beneficial effects of these agents on the heart. New methods based on pulse wave analysis complement sphygmomanometry in assessing ill effects of aging and benefits of drug therapy for hypertension.