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J Clin Hypertens (Greenwich). 2012;14:779–786. ©2012 Wiley Periodicals, Inc.

Once considered an inconsequential part of the aging process, the development of isolated systolic hypertension represents a late manifestation of increased elastic artery stiffness and is the predominant hypertensive subtype in the middle-aged and elderly populations. Its inherent increased risk for vascular events, such as coronary heart disease, stroke, heart failure, peripheral artery disease, chronic kidney disease, and dementia, highlights the importance of its control. The purpose of this short review is to summarize how hypertension is different in the elderly when compared with “essential hypertension” in younger adults. The emphasis will be on the multiple ways that increased artery stiffness affects the natural history and clinical manifestations of hypertension in the elderly.