Related Experiment Videos
Age-related hemodynamic, renal, and hormonal differences among patients with congestive heart failure
1Department of Medicine, New York Hospital-Cornell University Medical College, NY.
Insights
Elderly patients with heart failure show increased vasoconstriction and blunted heart rate response. Renal function is compromised in older adults with chronic congestive heart failure (CHF), impacting treatment outcomes.
Area of Science:
- Cardiology
- Geriatrics
- Nephrology
Background:
- Heart failure (HF) affects both younger and elderly populations, but distinct physiological characteristics may exist in older adults.
- Understanding age-related differences in HF is crucial for optimizing therapeutic strategies and clinical trial design.
Purpose of the Study:
- To identify specific characteristics differentiating elderly ( > 65 years) from younger patients with chronic congestive heart failure (CHF).
- To investigate the impact of aging on hemodynamic, hormonal, and renal function in patients with CHF.
Main Methods:
- Studied 128 consecutive patients with CHF, measuring systemic hemodynamics, vasoactive hormones, sodium status, and renal function.
- Assessed hemodynamic response to head-up tilt (n=65) and renal blood flow/function using clearance techniques (n=46).
Main Results:
- Elderly CHF patients had higher rates of ischemic heart disease, increased systemic vascular resistance, and attenuated heart rate response to tilt.
- Aging correlated with increased circulating norepinephrine, elevated serum urea nitrogen and creatinine, decreased glomerular filtration rate, and noncompensatory filtration fraction.
- Renal vascular resistance increased with age despite reduced filtration.
Conclusions:
- Elderly patients with CHF exhibit enhanced vasoconstriction, blunted heart rate responsiveness, and elevated norepinephrine.
- Renal function is significantly impaired in elderly individuals with CHF.
- Age-related physiological changes superimposed on CHF necessitate consideration in drug therapy response and clinical trial interpretation.
Abstract:
The purpose of this study was to determine if there were characteristics that distinguish elderly patients with heart failure (greater than 65 years of age) from younger patients with heart failure. We studied 128 consecutively admitted patients with chronic congestive heart failure (CHF) under uniform conditions, with measurement of systemic hemodynamics, vasoactive hormones and sodium status, and renal function. Additional characterization included the hemodynamic response to gravitational stress (head-up tilt; n = 65), and renal blood flow and function by steady-state clearance techniques (n = 46). Compared with younger patients with CHF, there was a greater frequency of ischemic heart disease in the elderly patients with CHF. Within the CHF population there was an increase of systemic vascular resistance and a trend of decreased heart rate with aging. Heart rate responsiveness was attenuated during tilt according to age. Circulating norepinephrine increased with aging, but a clear-cut age-related effect was not observed for renin system activity or sodium status. Both serum urea nitrogen and serum creatinine increased with age. More detailed renal studies confirmed an age-related decrease of glomerular filtration rate and a noncompensatory filtration fraction, despite increasing renal vascular resistance. We conclude that elderly patients with CHF have relatively greater vasoconstriction (or decreased compliance) and blunted heart rate responsiveness associated with increased circulating norepinephrine. Furthermore, renal function in the elderly patient with CHF is markedly compromised. These findings are consistent with superimposition of an aging effect on the CHF process, which must be considered in evaluating the response to drug therapy and the outcome of multicenter CHF trials.