Related Experiment Videos
Hypertension in the elderly: age- and disease-related complications and therapeutic implications
E G Lakatta1, J D Cohen, J L Fleg
1Laboratory of Cardiovascular Science, National Institute on Aging, Baltimore, MD 21224.
Insights
Treating hypertension in older adults requires understanding aging
Area of Science:
- Cardiology
- Gerontology
- Pharmacology
Background:
- Aging significantly impacts cardiovascular structure and function, leading to changes resembling 'muted' hypertension in the elderly.
- Elderly hypertensive patients often present with comorbidities like atherosclerosis, renal dysfunction, and diabetes, complicating treatment.
- Isolated systolic hypertension (ISH) is prevalent in the elderly and a strong predictor of cardiovascular events.
Purpose of the Study:
- To review the impact of aging on cardiovascular function in relation to hypertension.
- To discuss the challenges and effective treatment strategies for hypertension in the elderly, particularly ISH.
- To explore the role of vasodilators, such as calcium antagonists, in managing elderly hypertension.
Main Methods:
- Literature review analyzing cardiovascular changes associated with aging and hypertension.
- Examination of treatment outcomes for isolated systolic hypertension in the elderly.
- Analysis of the mechanisms of action for vasodilators in reducing arterial load.
Main Results:
- Elderly individuals, even without hypertension, exhibit cardiac and vascular changes similar to younger hypertensive patients.
- Treatment of ISH in the elderly has been demonstrated to be safe and effective in lowering systolic pressure.
- Vasodilators, including calcium channel blockers, can reduce peripheral vascular resistance and arterial stiffness, benefiting elderly hypertensive patients.
Conclusions:
- Effective hypertension management in the elderly necessitates considering age-related cardiovascular alterations and comorbidities.
- Isolated systolic hypertension treatment is crucial for reducing cardiovascular morbidity and mortality in older adults.
- Calcium channel blockers show promise in ameliorating cardiac hypertrophy and diastolic dysfunction in elderly hypertensive patients by reducing arterial load.
Abstract:
Effective treatment of hypertension in the elderly requires an understanding of both the progressive course of the disease and the impact of aging on the cardiovascular system, including physiological, genetic, lifestyle, and environmental factors. Review of the literature that has attempted to define the impact of an "aging process" on cardiovascular structure and function reveals a diversity of findings and interpretations. However, in general, normotensive elderly subjects exhibit the heart and vascular characteristics of "muted" hypertension, including many features of younger hypertensive patients: cardiac hypertrophy, diminution in resting left ventricular early diastolic filling rate, increased arterial stiffness and aortic impedance, diminution in the baroreceptor reflex, a diminished response to catecholamines and diminished renal blood flow, and an increase in peripheral vascular resistance (PVR). Treatment of elderly hypertensives is more challenging because of the greater likelihood of the presence of concomitant diseases, most importantly, coronary and peripheral atherosclerosis, renal dysfunction, and diabetes mellitus. Isolated systolic hypertension (ISH), the most common form of hypertension in the elderly, has also been clearly shown to be an important predictor of cardiovascular morbidity and mortality, including coronary artery disease, congestive heart failure, and stroke. Treatment of ISH has been shown to lower systolic pressure safely and effectively in the elderly. By reducing PVR, and possibly the arterial stiffness, and thus the early reflected pulse waves, vasodilators, including calcium antagonists, may lower these three components of arterial impedance, and hence lower the arterial load on the heart. The cardiac hypertrophy and reduced left ventricular filling rate associated with hypertension in older individuals can also be ameliorated, to some extent, by calcium channel blockers.