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Hypertension and atherosclerosis in the elderly: pathogenetic common mechanism and intervention strategies
V Marigliano1, A Scuteri, M Cacciafesta
1Cattedra Gerontologia e geriatria, Università di Roma La Sapienza, Policlinico Umberto I, Italy.
Insights
Hypertension in the elderly is linked to metabolic issues like hyperinsulinism, contributing to atherosclerosis. A new hypothesis suggests managing cellular sodium transport and diet can prevent cardiovascular events.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Metabolic Disorders
Background:
- Hypertension is a primary cause of mortality in Western elderly populations.
- Hypertension in the elderly is often a complex, multifaceted condition linked to metabolic disorders.
- Hyperinsulinism is a potential pathogenetic factor connecting hypertension and atherosclerosis progression.
Purpose of the Study:
- To propose a unified pathogenetic hypothesis for hypertension and atherosclerosis in the elderly.
- To identify key factors in the development of hypertension and atherosclerosis.
- To guide the management of elderly hypertensive patients towards preventing cardiovascular events.
Main Methods:
- Reviewing the multifactorial nature of hypertension in the elderly.
- Investigating the role of cellular sodium transport systems.
- Analyzing the modulatory effects of environmental factors, particularly insulin.
Main Results:
- A hypothesis linking inborn cellular transport alterations and environmental factors (insulin) to hypertension and atherosclerosis.
- Dietary management focusing on sodium and lipid intake is crucial.
- Pharmacological treatments like calcium antagonists and ACE inhibitors are beneficial.
Conclusions:
- Elderly hypertension management should prioritize preventing cerebro- and cardiovascular events.
- A pathogenetic treatment approach involves dietary modifications and specific pharmacological interventions.
- Treatment should consider and positively modulate cellular sodium transport systems and associated metabolic disorders.
Abstract:
Hypertension is the leading cause of death in the elderly in Western countries. The Authors remark that hypertension is not only a purely hemodynamic phenomenon, but is a multifaceted disease frequently associated with metabolic disorders in the elderly. Among the latter, hyperinsulinism could be the linking pathogenetic factor with atherosclerosis progression. Then the Authors suggest a unitary pathogenetic hypothesis of hypertension and atherosclerosis. The crucial points are the inborn alteration of cellular sodium transport systems and the modulating action of environmental factors, first of all insulin. According to this hypothesis, the goal of the management of elderly hypertensives is the prevention of the fatal or invalidant cerebro- and cardiovascular event. To follow a good "pathogenetic" treatment of elderly hypertension and atherosclerotic process evolution, the first step is a dietetic approach avoiding acute load of sodium and lipids. Furthermore, the pharmacological treatment with calcium antagonists and ACE inhibitors is respectful of associated metabolic disorder and positively modulate the cellular sodium transport systems activity.