Age-Related Hemodynamic, Renal, and Hormonal Differences Among Patients With Congestive Heart Failure

Cody, Robert J.; Torre, Sabino R.; Clark, Mary Ann; Pondolfino, Kathleen

doi:10.1001/archinte.1989.00390050029006

Cited by 54 publications

(22 citation statements)

References 51 publications

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“…The prevalence of HF rises from 2% to 3% at age 65 to more than 80% in persons over 80 years of age (537), and HF is the most common reason for hospitalization in elderly patients (538-541). The high prevalence of HF in the elderly may be associated with age-related changes in ventricular function (particularly diastolic function) and to the cumulative effects of hypertension and other chronic risk factors (542)(543)(544)(545)(546). In addition, risk factors for HF (e.g., hypertension, diabetes mellitus, and hyperlipidemia) are generally not treated aggressively in the elderly, yet elderly patients commonly take medications that can exacerbate the syndrome of HF (e.g., nonsteroidal anti-inflammatory drugs) (132).…”

Section: Elderly Patientsmentioning

confidence: 99%

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

Hunt

Abraham

Chin³

et al. 2005

Circulation

1,971

773

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Section: Elderly Patientsmentioning

confidence: 99%

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

Hunt

Abraham

Chin³

et al. 2005

Circulation

1,971

773

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“…It is well known that even normal aging is associated with some loss of renal tissue accompanied by changes in renal hemodynamics. 15 The observed decrease in ERPF and increase in FF and RVR is particularly pronounced in elderly persons with cardiovascular comorbidity such as hypertension and/or heart failure, 14,20,21 that is, conditions in which the availability of NO is reduced. 1 In this context, it has not been resolved whether age-related changes in renal hemodynamics are caused by structural abnormalities or whether there exists a functional abnormality as well, for example, reduced capacity of renal vessels to dilate as a consequence of reduced availability of (or responsiveness to) vasodilator substances.…”

Section: Discussionmentioning

confidence: 99%

Asymmetric Dimethylarginine, Blood Pressure, and Renal Perfusion in Elderly Subjects

et al. 2003

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Background-Reduced availability of nitric oxide (NO) is thought to contribute to the age-associated increase of renovascular tone and blood pressure. We assessed blood concentrations of the endogenous NO synthase inhibitor asymmetric dimethylarginine (ADMA) as well as renal hemodynamics, comparing young (nϭ24, 13 men, 25Ϯ1 years) and elderly (nϭ24, 13 men, 69Ϯ2 years) healthy subjects and elderly subjects with essential hypertension (nϭ24, 13 men, 70Ϯ2 years). Methods and Results-Plasma ADMA concentration and renovascular resistance (RVR) were significantly higher (PϽ0.05) and effective renal plasma flow (ERPF) significantly lower (PϽ0.05) in elderly (2.77Ϯ0.20 mol/L, 125Ϯ10 mm Hg/mL per minute, 487Ϯ26 mL/min per 1.73 m 2 ) than in young healthy subjects (1.30Ϯ0.11, 77Ϯ3, 654Ϯ18). Both ADMA levels and RVR were higher and ERPF lower in the hypertensive elderly subjects (3.53Ϯ0.23, 163Ϯ11, 427Ϯ19; PϽ0.05 versus both groups). In contrast, plasma concentrations of the biologically inactive stereoisomer symmetric dimethylarginine, L-arginine, and homocysteine were similar in the 3 groups studied. In the logistic regression analysis only ADMA was an independent determinant of both ERPF (PϽ0.001; r 2 ϭ0.80) and RVR (PϽ0.002; r 2 ϭ0.86). In addition, ADMA (PϽ0.002) and serum glucose (PϽ0.036) were independently related (r 2 ϭ0.67) to the level of blood pressure. Conclusions-These results are compatible with the notion that accumulation of the endogenous NO synthase inhibitor ADMA in senescent individuals is involved in the decrease of renal perfusion and increase of blood pressure.

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“…This is associated with increased plasma noradrenaline and serum creatinine concentrations [97]. The therapeutic implications of some pharmacokinetic changes involving the main agents used for the treatment of this condition are discussed.…”

Section: Congestive Heart Failurementioning

confidence: 99%

“…Studies investigating possible age-related differences in cardiovascular function in patients with congestive heart failure show a progressive decrease in heart rate and an increase in systemic vascular resistance in older patients [97]. This is associated with increased plasma noradrenaline and serum creatinine concentrations [97].…”

Section: Congestive Heart Failurementioning

confidence: 99%

Age‐related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications

Mangoni

Jackson

2003

Brit J Clinical Pharma

1,384

911

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Advancing age is characterized by impairment in the function of the many regulatory processes that provide functional integration between cells and organs. Therefore, there may be a failure to maintain homeostasis under conditions of physiolog ical stress. The reduced homeostatic ability affects different regulatory systems in different subjects, thus explaining at least partly the increased interindividual variability occurring as people get older. Important pharmacokinetic and pharmacodynamic changes occur with advancing age. Pharmacokinetic changes include a reduction in renal and hepatic clearance and an increase in volume of distribution of lipid soluble drugs (hence prolongation of elimination half-life) whereas pharmacodynamic changes involve altered (usually increased) sensitivity to several classes of drugs such as anticoagulants, cardiovascular and psychotropic drugs. This review focuses on the main age-related physiological changes affecting different organ systems and their implications for pharmacokinetics and pharmacodynamics of drugs.

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Age-Related Hemodynamic, Renal, and Hormonal Differences Among Patients With Congestive Heart Failure

Cited by 54 publications

References 51 publications

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

Asymmetric Dimethylarginine, Blood Pressure, and Renal Perfusion in Elderly Subjects

Age‐related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications

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