Management of Isolated Systolic Hypertension (ISH), Suspected Hypertensive Retinopathy and Immobility of Elderly Patient in Family Medicine



  • Karimah Khitami Aziz Medical Faculty, Lampung University
  • Dian Isti Angraini universitas lampung



Elderly patient, family medicine, isolated Systolic Hypertension.


Isolated Systolic Hypertension (ISH) is an increase of systolic blood pressure (BP) without diastolic BP common in old age. ISH may develop from a history of chronic essential hypertension or result from arterial stiffness in normotensive person. Secondary causes of arterial stiffness are type 1 diabetes, osteoporosis with calcification, atherosclerosis, peripheral vascular disease, thyrotoxicosis and aortic disorders. Implementation of family medicine and evidence based medicine by identifying risk factors, clinical problems and management based on a patient centered and family approach. This study is a case report. Primary data were obtained through history taking, physical examination and home visit. The assessment based on the holistic initial diagnosis, process and final diagnosis by in-depth interviews, observation and notes. The patient complained of intermittent headaches and blurred vision since 1 week ago. Complaints for the first time and never been treated. The patient's concern with the complaint interferes with his activities and rest. The patient's expectation of complaints is reduced and not worsen. Patients' perceptions of complaints occur due to certain lifestyles causing diseases that are not known for sure by patient and their family. The patient was diagnosed with grade II ISH. The patient's father had history of hypertension and heart disease. The patient's treatment pattern is curative, rarely has light physical activity, lack of knowledge about the disease, inappropriate diet and eating habits, elderly age and lack of family knowledge about the disease and its complications. Functional degree 2. After the intervention shows clinical improvement and changes in behavior. ISH in the elderly with insufficient knowledge about risk factors, drug use and adherence to BP control can cause acute and advanced complications.


Fabio A, Paolo V, Sergio M, Gaetano V, Gianpaolo R. 2020. Treatment strategies for isolated systolic hypertension in elderly patients. Department of Medicine, University of Perugia, Perugia, Italy.

Older Americans; Key indicators of well-being. Federal Interagency Forum on Aging-Related Statistics. 2016. Diambil dari: https://agingstatsgov/docs/LatestReport/Older-Americans-2016-Key-Indicators-of-WellBeingpdf.

Buford TW. Hypertension and aging. Ageing Res Rev. 2016; 26: 96-111.

Hodgson TA dan Cai L. Medical care expenditures for hypertension, its complications and its comorbidities. Med Care. 2001; 39 (6): 599-615.

Hodgson TA dan Cohen AJ. Medical care expenditures for selected circulatory diseases: opportunities for reducing national health expenditures. Med Care. 1999; 37 (10): 994-1012.

Muntner P, Carey RM, Gidding S. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018;137 (2): 109-18.

Whelton PK, Carey RM, Aronow WS. Guideline for the prevention, detection, evaluation and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2018; 71 (19): 227-48.

Bundy JD, Mills KT, Chen J. Estimating the association of the 2017 and 2014 hypertension guidelines with cardiovascular events and deaths in US adults: an analysis of national data. JAMA Cardiol. 2018; 3 (7): 572-81.

Kearney PM, Whelton M, Reynolds K. Global burden of hypertension: analysis of worldwide data. Lancet. 2005; 365 (9455): 217-23.

Kearney PM, Whelton M, Reynolds K. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004; 22 (1): 11-9.

Mozaffarian D, Benjamin EJ, Go AS. Heart disease and stroke statistics update: a report from the American heart association. Circulation. 2015; 131 (4): 22-9.

Chobanian AV. Clinical practice: Isolated systolic hypertension in the elderly. N Engl J Med. 2007; 357 (8): 789-96.

Franklin SS. Elderly hypertensives: how are they different? J Clin Hypertens (Greenwich). 2012; 14 (11): 779-86.

Chobanian AV. Clinical practice; isolated systolic hypertension in the elderly. N Engl J Med. 2007; 357 (8): 789-96.

Chirag B, Sangita G, Franz H, Messerli. Isolated systolic hypertension: an update after sprint. The American Journal of Medicine. 2016; 129 (12): 1251-58.

Bangalore S, Fakheri R, Toklu B, Messerli FH. Diabetes mellitus as a compelling indication for use of renin angioten system blockers: systematic review and meta-analysis of randomized trials. BMJ. 2016; 352: 438.

Ong KT, Perdu J, De Backer J. Effect of celiprolol on prevention of cardiovascular events in vascular Ehlers-Danlos syndrome: a prospective randomised, open, blinded-endpoints trial. Lancet. 2010; 376 (9751): 1476-84

Mancia G, Fagard R, Narkiewicz K. 2013. ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the european society of hypertension (ESH) and of the european society of cardiology (ESC). Eur Heart J. 2013; 34 (28): 2159-219



How to Cite

Karimah Khitami Aziz, & Dian Isti Angraini. (2021). Management of Isolated Systolic Hypertension (ISH), Suspected Hypertensive Retinopathy and Immobility of Elderly Patient in Family Medicine: Indonesia. Medical Profession Journal of Lampung, 10(4), 767-776.




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