Osler's maneuver, pseudohypertension, and true hypertension in the elderly

Up to half of the geriatric population has been reported to have arterial hypertension and, therefore, an augmented risk of heart attack, stroke, congestive heart failure, and sudden death. Recent studies indicate that mechanisms serving to elevate arterial pressure in the elderly diametrically differ from those in younger patients with similar elevation of arterial pressure. Elderly hypertensive patients have a low cardiac output, elevated vascular resistance, impaired tissue flow, and increased arterial stiffness. Arterial stiffness, if marked, can give rise to pseudohypertension--an entity often responsible for inappropriate diagnosis and inappropriate therapy in the geriatric population. Pseudohypertension can be suspected from a simple bedside maneuver that was hinted at by Sir William Osler almost a century ago. Arterial hypertension seems to accelerate the physiologic process of aging in the cardiovascular system and threatens, therefore, to set the biologic clock at a faster pace. Hopefully, antihypertensive agents more closely tailored to underlying mechanisms of pressure elevation will reverse hypertensive damage to target organs and thereby reset the aging process of the cardiovascular system at a slower pace.