[Old age from the viewpoint of the cardiologist]

The general cardiovascular performance of old people is determined by: a) inherent changes of the cardiovascular system which develop with age; b) delay of degenerative changes in some subjects caused by genetic factors, optimal physical activity and a proper diet; c) acquired diseases, in particular arteriosclerosis and hypertension. As a result of degenerative changes of the vascular wall the systolic pressure rises advancing age, some of the old people develop isolated systolic hypertension. Mild hypertrophy of the left ventricle develops also. The contracting ability of the heart muscle is preserved, the ejection fraction at rest and the cardiac output do not change. However, the diastolic function changes significantly-the elasticity of the left ventricle declines and its filling depends more on the atrial systole. A frequent cause of heart failure in old people is diastolic dysfunction. Pharmacotherapy of old people has some specific features which are discussed in more detail. A recent multicentre clinical investigation SHEP proved unequivocally, that effective treatment of systolic hypertension reduced in old people the risk of cerebrovascular attacks by 33%, of acute myocardial infarction by 27% and of cardiac failure by more than 50%! Based on these results it is clear that systolic hypertension must be treated equally systematically as diastolic hypertension. The approach to old people with cardiovascular disease must be strictly individual. Age alone must not be the reason for refusing access to the complete spectrum of modern diagnostic and therapeutic possibilities.