A 72-year-old man has blood pressure 168/64 mmHg recorded on three visits. Echocardiography shows a normal ejection fraction and normal stroke volume. The most likely explanation for his isolated systolic hypertension is:

• A Increased circulating catecholamines
• B Reduced aortic compliance from medial degeneration and stiffening with age ✓
• C Excessive renin secretion
• D Arteriovenous fistula increasing cardiac output

Explanation

With each systole, a compliant aorta cushions the ejected stroke volume, limiting systolic rise and storing elastic energy that sustains diastolic flow. Age related medial elastin fragmentation and collagen deposition reduce this Windkessel compliance, so systolic pressure rises sharply while diastolic pressure falls, widening pulse pressure. Stroke volume and cardiac output are normal here, excluding high output states such as arteriovenous fistula. Renin excess typically raises diastolic as well as systolic pressure.

Reference: Guyton and Hall Textbook of Medical Physiology, 14th ed.

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