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    Hipertensi and Age

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    6 views4 pages

    Hipertensi and Age

    Uploaded by

    hendrojoli
    Hipertensi and Age

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 4
    rarane vn madocapacomviewatideTOHB pit ‘wwnw.medscape.com Hypertension in Aging Patients Nevander G Logan Expert Rev Cardiovase Ther. 2011,9(1} 113-120. Abstract and Introduction Abstract Hypertension, especially isolated systolic hypertension, is commonly found in alder (60-79 years of age) and elderly (280 years of age) people. Antinypertensive drug therapy should be considered in all aging hypertensive patients, as ‘treatment greatly reduces cardiovascular events. Most classes of antihypertensive medications may be used as first-line treatment with the possible exception of a- and P-blockers. An inital blood pressure treatment goal is less than 140/90, ‘mig in all older patients and less than 150/80 mmHg in the nonfrail elderly. The current paradigm of delaying therapeutic interventions until people are at moderate or high cardiovascular risk, a universal feature of hypertensive patients over 60 years of age, leads to vascular injury or disease that is only partially reversible with treatment. Future ‘management wil ikely focus on intervening eadier to prevent accelerated vascular aging and irreversible arterial damage. Introduction Hypertension is highly prevalent disorder in older people. Ina recent population-based survey of adults aged 20-79 years in Canada, hypertension, defined as a blood pressure of 140/90 mmHg oF more or being on antihypertensive medications, was present in 21.3% ofthe population overall and 51.6% among those 60-79 years of age." Similar or ‘even higher age-dependent prevalence rates have been reported worldwide.) Hypertension is a major risk factor for cardiovascular and renal disease, and numerous dincal trials including studies in older subjects have documented that effective treatment improves survival and confers cardiovascular benefits. 4) “The sim of this article is to summarize current knowledge about hypertension in aging individuals. In this artide, older people aged 60-79 years are considered separately from the vary old or elderly, defined as 80 years of age or more. The presence of comorbid conditions such as diabetes melitus, chronic kidney disease or previous cardiovascular disease, which increases with age, may affect the epidemiology of hypertension and approach to treatment, especialy Inthe eldery. Blood Pressure with Aging Blood pressure, particularly systolic blood pressure, rises with age, although the diastolic component of blood pressure begins to plateau around the age of 50 years and slowly dectines thereafter. I These temporal changes in blood prossure increase pulse pressure and are associated with a dramatic rise inthe prevalonos of do novo isalated systolic hypertension. In a community-based prospective cohort study, more than 90% of normatensive adults in midlife ‘develop hypertension in their lifetime. 1 The discrepant trends in systolic and diastolic blood pressure provides an ‘explanation forthe change in the relative proportion of different forms of hypertension with age. In the National Health ‘and Nutrition Examination Suey (NHANES Ill; 1988-1981), less than 20% of hypertensive individuals older than 60, Yeer of ape had an elevted cai Hood pressure, end the proportion dened stay rm te sith decade ‘onward Epidemiology of Hypertension with Aging Major overviews of observational studies have shawn a continuous and positive relationship between cardiovascular ‘events and usual blood pressure above a baseline level of approximately 115/75 mmHg at all ages and in both sexes. 71 although the strength of the association weakens with age, the absolute difference in cardiovascular risk between pws medscape com ewartcla EBD pet 19 rarane vn madocapacomviewatideTOHB pit the highest anc lowest usual blood pressure levels is much greater in older subjects. Thus, the burden of disease that is potentially avoidable by blood pressure-lowering treatment would be expected to be greater in older individuals. In general, these population-based cohort studies were conducted in adults with no previous vascular disease. Thus, the results may not necessarily be applicable to subjects with significant comorbid diseases. For example, in a study of regular users of Veterans Alfairs outpatient dinics in the USA, elderly hypertensive patients with controlled hypertension in the high normal blood pressure range lived significantly longer than those whose bload pressure was Jower.!*l Furthermore, in hypertensive patients whose initial blood pressure was in the range considered to be Lncontrlled, survival was nat significantly reduced for each 10 mmHg increase in systolic blood pressure or diastolic blood pressure. The term reverse epidemiology has been used to describe the pattern of increased survival associated with higher blood pressure, and the phenomenon likely reflects the confounding effects of other comorbid conditions. In the Oates ef al. study, more than 40% of the subjects had coronary heart disease, approximately 18% had ‘cerebrovascular disease and almost 10% had chronic renal failure.!*l The findings underscore the importance of taking into account the characteristics of the subjects when making treatment decisions and recognizing that a lower blood pressure may be a proxy for poor health and a waming sign that further blood pressure lowering may actually be harmful. Thus, lower may not always be better. Pathophysiology of Age-related Hypertension “The aorta and its major branches act as cstensible tubes that promote the conversion of the pulsatile output ofthe hear into a steady stream in the peripheral circulation. With agin, there isa progressive oss ofthe visco~lastic properties of conduit vessels, increased atherosclerotic arterial disease, and hypertrophy and sclerosis of muscular arteries and arterioles." These vascular changes load toa loss ofthe cushioning function of the conduit vessels and Stitfening of the ate vasculature overall, which promote the eat return of reflected waves fram the peripheral ‘etl circulation. Early wave reflection amplifies the systlc pressure wave generated with each hear beat, leading to an increas in systolic pressure and a fll in clastic pressure ‘Aging is also associated with an increase in total (and ronal vascular resistance and left ventricular mass indox, and a

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