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Pathophysiology of hypertension in the elderly
Stéphane Laurent1, Pierre Boutouyrie, Athanase Benetos
1Department of Pharmacology, EMI-U 0107 Inserm, Hopital Europeen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. stephane.laurent@egp.ap-hop-paris.fr
Insights
Systolic hypertension, common in older adults, stems from stiff arteries. This review explores how aging and blood pressure impact arterial stiffness, highlighting research gaps in the elderly.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Physiology
Background:
- Systolic hypertension is prevalent in the elderly, representing a significant modifiable cardiovascular risk.
- It is characterized by wide pulse pressure, primarily due to increased large artery stiffness.
- Arterial stiffness escalates with age, irrespective of mean blood pressure or other risk factors.
Purpose of the Study:
- To review the effects of aging and blood pressure on arterial stiffness.
- To discuss the physiology of arterial compliance and age-related anatomic changes in large arteries.
- To identify research gaps concerning arterial stiffness in the elderly, particularly those over 70.
Main Methods:
- Literature review focusing on studies examining arterial stiffness in elderly populations.
- Analysis of physiological mechanisms underlying arterial compliance and anatomic changes.
- Examination of existing data on the influence of age and gender on arterial stiffness and wave reflection.
Main Results:
- Arterial stiffness increases with age, contributing to systolic hypertension in the elderly.
- Age-related anatomic changes in large arteries are a key factor in reduced arterial compliance.
- Existing research often involves small elderly cohorts, limiting understanding of age and gender effects.
Conclusions:
- Systolic hypertension in the elderly is strongly linked to increased arterial stiffness.
- Further research is essential to understand the pathophysiology, epidemiology, and pharmacology of hypertension in this demographic.
- Investigating the specific roles of age and gender in arterial stiffness and wave reflection in individuals over 70 is crucial.
Abstract:
Systolic hypertension is the most common type of hypertension in the elderly and a major modifiable cardiovascular risk factor. Systolic hypertension is associated with a wide pulse pressure resulting largely from excessive large artery stiffness. Arterial stiffness increases with age independently of mean blood pressure or the presence of other risk factors. In this review, the authors discuss the effects of age and blood pressure on arterial stiffness, the physiology of arterial compliance, and the anatomic changes of large arteries with aging. In most studies reported in the literature, elderly populations are relatively small. The role of both age and gender on arterial stiffness and wave reflection has been poorly investigated, particularly in subjects over 70 years. In this elderly population, further research is needed concerning the pathophysiology, epidemiology, and pharmacology of hypertension.