Hypertension in the elderly: Age- and disease-related complications and therapeutic implications

Edward Lakatta, Jerome D. Cohen, Jerome L. Fleg, Edward D. Frohlich, Alan H. Gradman

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
Pages (from-to)643-653
Number of pages11
JournalCardiovascular Drugs and Therapy
Volume7
Issue number4
DOIs
StatePublished - Aug 1993
Externally publishedYes

Fingerprint

Hypertension
Vascular Resistance
Vascular Stiffness
Cardiomegaly
Electric Impedance
Coronary Artery Disease
Therapeutics
Baroreflex
Renal Circulation
Calcium Channel Blockers
Cardiovascular System
Vasodilator Agents
Catecholamines
Blood Vessels
Pulse
Life Style
Diabetes Mellitus
Heart Failure
Stroke
Blood Pressure

Keywords

  • arterial impedance
  • cardiac hypertrophy
  • elderly hypertensive
  • peripheral vascular resistance
  • therapeutic considerations

ASJC Scopus subject areas

  • Pharmacology
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Hypertension in the elderly : Age- and disease-related complications and therapeutic implications. / Lakatta, Edward; Cohen, Jerome D.; Fleg, Jerome L.; Frohlich, Edward D.; Gradman, Alan H.

In: Cardiovascular Drugs and Therapy, Vol. 7, No. 4, 08.1993, p. 643-653.

Research output: Contribution to journalReview article

Lakatta, Edward ; Cohen, Jerome D. ; Fleg, Jerome L. ; Frohlich, Edward D. ; Gradman, Alan H. / Hypertension in the elderly : Age- and disease-related complications and therapeutic implications. In: Cardiovascular Drugs and Therapy. 1993 ; Vol. 7, No. 4. pp. 643-653.
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