1. ¹Cattedra di Cardiologia, II Facoltà di Medicina e Chirurgia, Università di Roma 'La Sapienza', Rome, Italy
2. ²IRCCS Neuromed, Pozzilli, IS, Italy

Correspondence: Dr M Volpe, Cattedra di Cardiologia, II Facoltà di Medicina e Chirugia, Università di Roma 'La Sapienza', Ospedale Sant'Andrea, Via di Grottarossa, 1035, 00189 Roma, Italy. E-mail: volpema@uniroma1.it

Received 15 March 2004; Revised 16 July 2004; Accepted 16 July 2004; Published online 30 September 2004.

Abstract

Systolic blood pressure has a continuous, graded, strong, independent, and aetiologically significant relationship to mortality from coronary heart disease, stroke, and all cardiovascular diseases, as well as to all-cause mortality and life expectancy. Angiotensin II (AII) may be intimately involved in the pathogenesis of systolic hypertension through multiple mechanisms, including decreasing the elastin content and increasing the collagen content of the arterial wall, thickening and fibrotic remodelling of the vascular intima, and proliferating smooth muscle cells in the arterial wall, resulting in increased thickness, stiffening, and partial loss of contractility. AII antagonists may therefore offer hitherto unrecognized benefits (independent of blood pressure) on age-related vascular damage and provide particular benefits in patients with systolic hypertension. Recent evidence has demonstrated that losartan offers cardiovascular outcomes benefits in isolated systolic hypertension (ISH) associated with an excellent tolerability profile. This, in patients with ISH, AII antagonists more facilitate systolic BP control, providing cardiovascular protection and offering an excellent risk-benefit profile.