Hypertension and Its Treatment in the Elderly
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 13, Issue 1
Abstract
The treatment of hypertension has been shown to be accompanied by a reduction in mortality and morbidity both in older and younger hypertensive patients. In the elderly hypertensive patients BP should be lowered to a systolic value of 130-139 mmHg and a diastolic value of < 80 mmHg if tolerated. Treated SBP values of < 130 mmHg should be avoided and in the elderly hypertensive patients it should be advised to undertake treatment together with an evaluation of the presence of other comorbidities and the risks associated with multi-therapy, especially in the older. Hypertension is a known risk factor for cardiovascular morbidity and mortality and in the long term one of the main causes of end stage renal disease. The definition of hypertension does not change with age: office blood pressure value at least 140 mmHg for systolic blood pressure (SBP) and diastolic blood pressure (DBP) at least 90 mmHg is defined as grade 1 hypertension [1]. Although rise in blood pressure is not a normal part of aging, the incidence of hypertension in the elderly population is high. In the 1988-2004 National Health and Nutrition Examination Survey 67% of adults aged 60 and older were found to be hypertensive [2]. Data from the Framingham study show that 58.9% of people aged ≥65 and 70% of those aged ≥80 years are hypertensive [3]. SBP rises progressively until the age of 70 or 80, whereas DBP increases until the age of 50 or 60 and then tends to level or even decline slightly. This combination of changes likely reflects aged related increase in stiffness of the blood vessels [4]. Arterial compliance is reduced by wall thickening, calcium accumulation, quantitative and qualitative alterations in collagen [5]. Baroreceptors sensitivity is altered with age and this may explain the variability of blood pressure revealed by continuous monitoring [6]. Vascular oxidative stress increases with aging, leading to pro-inflammatory phenotypical changes and an altered endogenous bioavailability of vasoactive substances with consequent impaired vascular function and changes in smooth muscle tone; this leads to an impairment of postural reflexes, making elderly hypertensive individuals more sensitive to orthostatic hypotension [7]. The loss of diastolic augmentation caused by the stiffness of major arteries leads to a fall in perfusion pressure in the coronary arteries, and changes in cerebrovascular circulation lead to reductions in cerebral perfusion [8]. Renal perfusion decreases with aging and determine an impairment of renal function with and reduction of the glomerular filtration rate [9]. All these changes could explain the decreased cardiac output, decreased heart rate, decreased myocardial contractility, nephroangiosclerosis, left ventricular hypertrophy seen in elderly patients and increased cardiovascular risk respect to general population. The cardiocerebrovascular-renal risk from hypertension is demonstrated by the higher incidence of stroke, left ventricular hypertrophy, congestive heart failure, coronary and peripheral artery diseases, vision impairment, end-stage renal disease, cognitive impairment, and dementia seen in the elderly hypertensive patients [10]. A large amount of evidences demonstrates that lowering blood pressure can substantially reduce this high morbidity and mortality [11-13].
Authors and Affiliations
Matteo Rigato, Laura Gobbi, Francesca Simioni, Luciana Bonfante, Federico Nalesso, Lorenzo A Calò
Keywords
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- EP ID EP594784
- DOI 10.26717/BJSTR.2019.13.002358
- Views 168
- Downloads 0
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