Hypertension in the Elderly

Abstract

In our aging society, most of the elderly aged >65 years are affected by systolic hypertension (HTN) [blood pressure (BP) >140 mmHg], which constitutes a major risk factor for organ damage and cardiovascular (CV) events. Management of HTN in the elderly represents a therapeutic dilemma because HTN trials had upper age limits or did not present age-specific results. However, the HYVET trial documented that therapy is beneficial even in those >80 years. In the elderly, systolic BP and pulse pressure emerge as potent risk factors for CV events. In the past an empiric formula "100+age" was used to estimate appropriate systolic BP. Diastolic BP is more important in younger people <50 years.

Hypertension in the elderly is due to increased stiffness and pulse wave velocity of the great arteries with earlier return of reflected waves, causing high systolic BP, low diastolic BP, increased myocardial oxygen demand with higher peripheral resistance and limited organ perfusion. Furthermore, decreased renal function contributes to HTN through volume expansion, increased intracellular sodium, reduced Na-Ca exchange; K⁺ excretion is limited and plasma aldosterone is low, so that the elderly are prone to drug-induced hyperkalemia. Autonomic dysfunction and venous insufficiency contribute to orthostatic hypotension, resulting in falls, syncope, CV events or orthostatic hypotension. Secondary HTN should also be considered, including renal artery stenosis, obstructive sleep apnea, primary aldosteronism, hyper- or hypo-thyroidism, tobacco, alcoholism, caffeine, use of no-steroidal anti-inflammatory drugs, glucocorticoids, sex hormones... (excerpt)