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Hypertension in the aged: a pathophysiologic basis for treatment
M A Weber1, J M Neutel, D G Cheung
1Section of Clinical Pharmacology and Hypertension, Veterans Administration Medical Center, Long Beach, California 90822.
The American Journal of Cardiology
|May 2, 1989
Summary
Hypertension affects over half of adults aged 65+, increasing cardiovascular risks. Newer antihypertensive drugs offer effective treatment with fewer side effects than traditional diuretics for older patients.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Hypertension is prevalent in individuals over 65, significantly increasing cardiovascular morbidity and mortality.
- Systolic blood pressure is a key predictor of adverse cardiovascular events in this demographic.
- Aging-related factors like arterial stiffening and baroreceptor changes contribute to hypertension in the elderly.
Purpose of the Study:
- To review the contributing factors to hypertension in older adults.
- To evaluate alternative antihypertensive treatments beyond traditional diuretics.
- To assess the efficacy and safety of newer agents in the elderly population.
Main Methods:
- Literature review of major surveys and clinical studies on hypertension in the elderly.
- Analysis of physiological changes associated with aging that impact blood pressure regulation.
- Comparison of traditional diuretic therapy with newer antihypertensive classes.
Main Results:
- Aging leads to decreased arterial compliance and altered baroreceptor sensitivity, often increasing systolic pressure.
- Sympathetic nervous system overactivity and potential sodium retention contribute to hypertension in older adults.
- Newer agents like sympatholytics, calcium channel blockers, and ACE inhibitors are effective and well-tolerated, with fewer adverse events than diuretics.
Conclusions:
- Effective management of hypertension in older adults requires consideration of age-specific physiological changes.
- Alternative antihypertensive medications offer improved efficacy and tolerability compared to diuretics.
- Certain antihypertensive agents can promote regression of left ventricular hypertrophy, further reducing cardiac risks.