[The hemodynamics of elderly hypertension]

The pathophysiology, of elderly hypertension is characterized by changes in the structure and function of the cardiovascular system. The hemodynamic status of elderly hypertensives is characterized by increased peripheral resistance as well as reduced cardiac output, renal blood flow and intravascular volume. In contrast to young hypertensives, the sympathetic and renin-angiotensin system may not be major factors in the genesis of high peripheral resistance in this patient group. Blood pressure increases with age even in the group of non-hypertensive subjects in most developed countries. Changes in arterial structure lead to a decrease in aortic compliance, which augments the aortic pressure component generated by the wave reflection mechanism. The age-related increase in the reflected-wave component of arterial pressure may contribute, significantly to the age-related rise in systolic blood pressure. In the heart, the reduced compliance is reflected by an age-related reduction in diastolic function. Thus, the changes in cardiovascular structures may play a major role in the change in the hemodynamics of elderly hypertension.