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(Hypertension. 2001;37:1067.)
© 2001 American Heart Association, Inc.

Editorial Commentary

Aging and Systolic Hypertension

Cluster Patterns and Problem-Solving Strategies to Answer the Genetic Riddle

Joseph L. Izzo, Jr

From the Millard Fillmore Hospital, Buffalo, NY.

Correspondence to Dr Joseph L. Izzo, Jr, Millard Fillmore Hospital, 3 Gates Circle, Buffalo, NY 14209.

Key Words: aging • hypertension, essential • telomeres • reactive oxygen species • menopause • evolution • genetics

	Introduction

 
In this issue of Hypertension, Abraham Aviv¹ provides a hypothetical approach to the deeply intertwined relationship between hypertension and aging in humans. He describes existing evidence for 3 different hypotheses that might explain why blood pressure increases with age: the "fetal origin hypothesis," which holds that a disorder of intrauterine growth, such as low birth weight, leads to abnormalities in later life; the theory of "antagonistic pleiotropy," which suggests that there was an evolutionary advantage to the hypertension phenotype because of natural selection of favorable traits closely linked to hypertension; and the theory of "telomere dependency," which holds that accelerated loss of telomeres (specific TTAGGG base pair sequence repeats at the terminal ends of mammalian chromosomes) limits cellular repair processes and causes vascular aging, stiff blood vessels, and systolic hypertension. To fully appreciate the nature of the problem under discussion, it may be wise to review the clinical impact of aging on blood pressure. In industrialized societies, there is a very steady age-related increase in systolic blood pressure, whereas diastolic pressure increases steadily until the sixth decade of life and then declines.² We are finally realizing that this complex age-related behavior of diastolic pressure significantly clouds the clinical definition of hypertension and that a clearer picture is possible through a paradigm shift to systolic blood pressure as the more important end point in diagnosis, risk stratification, and therapy of hypertension.³ The graphic representation of the complex relationship between aging and blood pressure in humans² should be prominently featured on . . . [Full Text of this Article]

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