The pathophysiology of hypertension. Differences between young and elderly patients
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Hypertension progresses from a hyperkinetic state in youth to increased systemic resistance and accelerated aging in adults. Even advanced hypertension in elderly patients may benefit from treatment, potentially reversing structural changes.
Area of Science:
- Cardiovascular Physiology
- Hypertension Pathophysiology
- Geriatric Cardiology
Background:
- Hypertension shows genetic predisposition signs in juveniles, often presenting as a hyperkinetic state.
- In established hypertension, cardiac output normalizes, with elevated systemic resistance and structural changes dominating.
- Chronic hypertension accelerates cardiovascular aging, leading to structural deterioration and reduced functional reserve.
Purpose of the Study:
- To elucidate the progression of cardiovascular changes in hypertension from youth to old age.
- To understand the impact of chronic hypertension on cardiovascular structure and function over time.
- To assess the potential for therapeutic intervention to reverse structural changes in elderly hypertensive patients.
Main Methods:
- Review of cardiovascular adaptations during hypertension development.
- Analysis of age-related cardiovascular changes in hypertensive individuals.
- Evaluation of recent studies on treatment efficacy in advanced hypertension.
Main Results:
- Juvenile hypertension characterized by increased cardiac output; adult hypertension by elevated systemic resistance and structural resetting.
- Chronic hypertension accelerates cardiovascular aging, causing stiffening, reduced Windkessel function, and impaired cardiac reserve.
- Elderly hypertensive patients exhibit pronounced, seemingly irreversible structural changes, yet treatment may still yield favorable responses.
Conclusions:
- Hypertension involves distinct cardiovascular alterations across age groups, progressing to accelerated aging and structural damage.
- Despite advanced structural changes in elderly patients, therapeutic interventions show promise for favorable outcomes.
- Treatment of late-stage hypertension may reverse observed structural changes, highlighting the importance of intervention even in older populations.
Abstract:
While structural and functional signs of a genetic predisposition to hypertension may sometimes be detected in the juvenile cardiovascular system, the borderline phase characteristic of young hypertensive patients is often dominated by a 'hyperkinetic' circulatory state. The modest pressure elevation is then mainly due to an increase in cardiac output and accentuated responses to neurohormonal stimuli. During the development of established hypertension, cardiac output gradually returns to normal and the high pressure state is largely a result of chronically elevated systemic resistance with cardiovascular 'structural upward resetting'. Signs of increased neurohormonal influences usually become less prominent. In general, the chronic high pressure state tends to accelerate ordinary cardiovascular aging, and therefore the advanced stages of primary hypertension are characterised by considerable interstitial infiltration with consequent wall stiffening and reduced aortic 'Windkessel' function. This further enhances the end-systolic afterload for the left ventricle, while at the same time myocardial strength and coronary reserve tend to decline. Age-related reductions in barostat function, reflex efficiency, and renal excretory capacity are also accentuated, and endothelial function suffers. Thus, the cardiovascular system in elderly hypertensive patients is generally characterised by pronounced and apparently poorly reversible structural changes. Nevertheless, recent studies indicate that even late phases of hypertension in elderly patients may respond favourably to treatment. This may predominantly reflect the high risk of serious cardiovascular damage in the elderly, but also that therapeutic intervention is able to reverse the structural changes observed in the advanced stages of hypertension.