AGING AND THE CARDIOVASCULAR-SYSTEM

Abstract

Incidence of hypertension is related to advancing age in most populations with the exception of some isolated tribes. In western countries, 30-40% of individuals over age 60 yr have resting blood pressure .gtoreq. 160/95 mmHg. Advancing age produces physiological changes related to blood pressure, e.g., decreased cardiac output, increased peripheral vascular resistance and decreased plasma renin-angiotensin-aldosterone levels. Decreased sensitivity of the baroreceptor reflex occurs but has not been correlated with pressure elevation. Hypertension is associated with increased morbidity and mortality due to cardiovascular disease in elderly hypertensives. Hypotensive treatment in the elderly has not been related to prolongation of life or to prevention or significant decrease of organ damage, especially of cerebrovascular accidents. Drastic blood pressure reduction can provoke serious side effects which decrease the quality of life. Hypotensive treatment is indicated in elderly hypertensive patients with hypertensive retinopathy grade III or IV, congestive heart failure or cerebral hemorrhage and in elderly patients with a markedly elevated diastolic blood pressure (.gtoreq. 120 mmHg). Hypotensive therapy may benefit milder forms of hypertension accompanied by angina, headache or dyspnea. Hypertension in the elderly is more difficult to manage than in younger patients. The dose regimen of the hypotensive drug is critical since volume depletion or orthostatic hypotension may occur.