Aging and the cardiovascular system

As a result of aging, a variety of structural and biochemical changes occur in arterial walls that result in hemodynamic adaptations. With age, there is a thickening of intima and media, together with an increase in the number of smooth muscle cells, synthesis of collagen and elastin, and deposition of calcium, glycosaminoglycans, free and esterified cholesterol, and sphingolipids. These changes are similar to those observed in atherosclerosis, which is accompanied by marked increases of intimal smooth muscle cells and connective tissue constituents. The net effects of both aging and atherosclerosis are a loss of elasticity and distensibility. This results in a decrease in arterial compliance or capacitance, which in turn means that with increasing age systolic blood pressure (SBP) tends to be higher, and diastolic blood pressure (DBP) lower. As a consequence of structural changes both in myocardium and vessels, cardiac output and renal and hepatic blood flow undergo adaptive alterations in order to meet the requirements of central hemodynamics and peripheral circulation. The implications of these processes of aging demand appropriate treatment of cardiovascular disorders, in particular hypertension, which occurs in 30-50% of patients above the age of 60 years. Appropriate treatment may demand dose adjustment and careful selection of antihypertensive drugs with a minimum of side effects, which additionally are capable of diminishing preload and afterload.