Accelerated decline in renal perfusion with aging in essential hypertension

The present cross-sectional study was designed to assess the effect of the severity of hypertensive cardiovascular disease and age on renal hemodynamics. In a homogeneous population of 157 white men (aged 15 to 87 years), we assessed renal and systemic hemodynamics by measuring mean arterial pressure invasively, renal blood flow by 131I-para-aminohippuric acid clearance, and cardiac output by the indocyanine dye dilution technique. Stepwise multiple regression analysis revealed the following independent determinants of renal blood flow: age (beta = -.42, P < .001), height (beta = +.14, P < .03), mean arterial pressure (beta = -.15, P < .02), and cardiac output (beta = +.19, P < .008). Renal blood flow corrected for height correlated inversely with age in all three groups. However, the renal fraction of cardiac output did not correlate with age in borderline hypertension (r = .17, P = NS) and in normotension (r = .12, P = NS), suggesting a parallel decline in renal blood flow and cardiac output with aging. In contrast, in established hypertension, the renal fraction of cardiac output was closely linked to age (r = .52, P < .001) and significantly steeper (P < .01) than in normotension or borderline hypertension. We conclude that unlike in normotensive subjects or patients with borderline hypertension, patients with established hypertension have an accelerated decline in renal perfusion with aging, reflecting selective functional or structural changes or both in the renal vascular bed.