Pathophysiology and blood pressure measurements of hypertension in the elderly

Hypertension is a serious concern among the elderly, posing health risks and treatment challenges. In the first part of this review, we explore the pathophysiological mechanisms linking hypertension and aging, focusing on physiological changes such as arterial stiffening, in autonomic nervous system dysfunction, disruption of the renin-angiotensin-aldosterone system, aging-induced alterations in renal function, and the impact of salt-sensitive hypertension. The mnemonic "King/A+++/Hermès" aids in recalling the pathophysiology of aging-related hypertension. Accurate blood pressure measurements are important to determine the prognosis and treatment in the elderly; however, obtaining reliable measurement data in this population is not always easy, as changes in cardiovascular structure and hemodynamics with aging may lead to increased blood pressure variability. In the second part of this review, we evaluate the effectiveness of blood pressure monitoring in older adults, emphasizing the importance of precise measurements. We also assess the efficacy of home and ambulatory monitoring, discuss orthostatic hypotension and orthostatic hypertension, outline challenges in measuring blood pressure in individuals with atrial fibrillation, and explore the impact of aging on measurement errors. We conclude that understanding the interplay between hypertension and aging, coupled with precise blood pressure monitoring strategies tailored for older adults, is essential for effective management and to improve overall cardiovascular health in the elderly population.