Excess Body Weight, Insulin Resistance and Isolated Systolic Hypertension: Potential Pathophysiological Links.

Isolated systolic hypertension, the most common form of hypertension in the elderly, but also detectable among young and middle-aged subjects, is independently associated with higher risk of cardiovascular events and all-cause mortality. Among various pathophysiological changes associated with aging, excess body weight and insulin resistance may predispose to this type of hypertension. Overweight or frank obesity and their frequent companion insulin resistance could mediate the development of isolated systolic hypertension through increase in the renin-angiotensin-aldosterone system activity, in the sympathetic tone and in salt-sensitivity, all in turn leading to endothelial dysfunction, arterial stiffness and increase in blood pressure. This review will focus on this cluster of pathophysiological factors and on the mechanistic pathways whereby they may favor the development of isolated systolic hypertension.