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Relationship of Age With the Hemodynamic Parameters in Individuals With Elevated Blood Pressure
Shiwani Mahajan1,2, Jianlei Gu3,4, Cesar Caraballo1,2
1Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
Insights
Age is not a reliable indicator of hemodynamic profiles in individuals with elevated blood pressure (BP). While cardiac index decreases and systemic vascular resistance index (SVRI) increases with age, significant overlap exists across age groups.
Area of Science:
- Cardiovascular Physiology
- Geriatric Medicine
- Hypertension Research
Background:
- Hypertension prevalence and pathophysiology are linked to age.
- Limited data exists on age as a proxy for hemodynamic profiles in elevated blood pressure (BP).
- Understanding hemodynamic profiles is crucial for selecting appropriate hypertension therapies.
Purpose of the Study:
- To investigate the relationship between age and hemodynamic parameters in individuals with elevated BP.
- To determine if age adequately represents an individual's hemodynamic status for therapeutic decisions.
Main Methods:
- Cross-sectional study involving 45,082 individuals with elevated BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg).
- Noninvasive hemodynamic assessment using impedance cardiography.
- Data collected from 51 iKang Health Checkup Centers in China between January 2012 and October 2018.
Main Results:
- Cardiac index showed a negative association with age (per decade decrease of 0.17-0.24 L/min/m²).
- Systemic vascular resistance index (SVRI) demonstrated a positive association with age (per decade increase of 174.2-214.1 dynes·s·cm⁻⁵·m²).
- Substantial overlap in hemodynamic parameter distribution was observed across different age groups in both men and women.
Conclusions:
- Cardiac index decreases and SVRI increases with age in individuals with elevated BP.
- Age alone is insufficient to determine an individual's hemodynamic profile.
- Heterogeneity within age strata highlights the need for individualized hemodynamic assessment.
Background:
Age is known to be associated with the prevalence and pathophysiology of hypertension. However, there is little information on whether age stands as a good proxy for the specific hemodynamic profile of an individual with elevated blood pressure (BP), which could be important in the selection of therapy.
Design:
This is a cross-sectional study.
Setting:
People who underwent a noninvasive, hemodynamic assessment using impedance cardiography at 51 sites of iKang Health Checkup Centers throughout China between January 2012 and October 2018.
Participants:
We included 116,851 individuals, aged 20 to 80 years.
Main Outcomes And Measures:
Relationship between age and hemodynamic parameters (cardiac index, systemic vascular resistance index [SVRI]), among individuals with elevated BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg).
Results:
Final study population included 45,082 individuals with elevated BP: 29,194 men and 15,888 women with a mean (±SD) age of 48 (±13) and 54 (±12) years, respectively. Cardiac index was negatively associated with age with an adjusted, per decade decrease of 0.17 (95% confidence interval [CI] = 0.17-0.18) L/min/m2 in men and 0.24 (95% CI = 0.23-0.25) L/min/m2 in women. SVRI was positively associated with age with an adjusted, per-decade increase of 174.2 (95% CI = 168.8-179.7) dynes·s·cm-5 ·m2 in men and 214.1 (95% CI = 204.3-223.8) dynes·s·cm-5 ·m2 in women. However, there was substantial overlap in the distribution of these parameters across different age groups in both sexes.
Conclusions:
In this large study, we observed that cardiac index decreased and SVRI increased with age among individuals with elevated BP. Even though there was a general trend with age, we observed heterogeneity within age strata, suggesting that age alone is inadequate to indicate the hemodynamic profile for an individual. J Am Geriatr Soc 68:1520-1528, 2020.
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