Hypertension in the Elderly: An Evidence-based Review

Abstract

The progressive ageing of world population, and the increasing prevalence hypertension in elderly people are leading to the consideration that hypertension in the elderly is one of the main topic in hypertension treatment. Multiple mechanisms, including stiffening of large arteries, endothelial dysfunction, cardiac remodeling, autonomic dysregulation, renal aspects, contribute to the great prevalence of hypertension in the elderly and to increased cardiovascular morbidity and mortality. Treatment of hypertension can hardly put back older patients in a low risk category, especially if target organ damage is present. Nevertheless, blood pressure control can successfully prevent stroke, cognitive decline, coronary heart disease and heart failure, and reduce mortality in the elderly, and even in patients > 80 years, as recently demonstrated. Blood pressure should be lowered below 140/90 mmHg also in older patients. However the HYVET study suggests that a goal of 150/90 mmHg can be reasonable in patients aged 80 years or more. Drug treatment should be titrated with particular caution to adverse responses and excessive blood pressure lowering.

Acute stress does not impair long-term memory retrieval in older people

“…Exclusion criteria were: smoking more than 10 cigarettes a day, alcohol or other drug abuse, visual or hearing problems, diabetes, presence of an HPAaxis, neurological or psychiatric disease, using any medication directly related to emotional or cognitive functioning or able to influence hormonal levels, such as glucocorticoids, psychotropic substances or sleep medications, having been under general anesthesia once or more than once in the past year, and the presence of a stressful life event during the past year. Because hypertension is a common problem in the older population (Virdis et al, 2011), we decided not to exclude participants who were taking anti-hypertensive medication (men-stress = 7; women-stress = 5; men-control = 4; women-control = 8). Nevertheless, the statistical results and conclusions of this study do not change if we exclude those participants taking anti-hypertensive medication.…”

G-395A polymorphism in the promoter region of the KLOTHO gene and hypertension among elderly (90 years and older) Chinese individuals

“…Hypertension, one of the most common causes of preventable death, is known to increase with advancing age (Zeglin et al, 2009;Virdis et al, 2011). Hypertension is known to be the result of interactions between genetic and environmental factors (Kunes and Zicha, 2009).…”

Age influence on renalase and catecholamines concentration in hypertensive patients, including maintained dialysis

“…According to the study of Egan et al,25 two-thirds of older patients suffered from it. Older hypertensive adults experience cardiovascular events at a rate two to three times greater than younger patients with the same BP values 1. In the face of antihypertensive treatment benefits in older population, the knowledge of the pathogenesis of hypertension and CVD in elderly is crucial.…”

“…Hypertension in elderly patients is one of the main problems in cardiovascular diseases (CVDs) 1. Older hypertensive adults experience cardiovascular events at a rate two to three times greater than the younger with the same blood pressure (BP) values 2.…”