Vascular Ageing: Changing

the Way We Think About

Hypertension
Dr Stella N. Cookey
Consultant Physician/Lecturer
Essential hypertension
Introduction

• Hypertension remains a health challenge to the world as

hypertension is the highest cause of death globally.
• Male more than female until menopause when the sex
ratio is reversed
• A large percent is largely seen in the elderly
• However the prevalence in the younger age group is
growing.
Nigeria
• RANG 8%- 46.4%
• Males – 7.9% -50.2%
• Females – 6.5 to 68.8%
• Higher Urban to rural prevalence
• In all studies age was the most likely determinant irrespective
of gender.
• Higher intracelluar erythrocyte sodium(Ogunlesi)
• Higher sodium lithium counter transport(Obasohan)
• Higher noreadrenaline level (Adebiyi)
Hypertension is the Number One Risk Factor for Global Mortality

High Blood Pressure (BP)

Tobacco

High cholesterol

Underweight

Unsafe sex

High body mass index

Physical inactivity

Alcohol

0 1 2 3 4 5 6 7 8
Attributable mortality in millions (total: 55,861,000)

Ezzati et al. Lancet 2002;360:1347–60

Prevalence of high BP (≥20 years of age)
by age and sex (NHANES: 2007–2010)
AgestandardizedprevalenceofraisedBP,*
ages25+,males,2008
• Risk for Hypertension is multifactoral
• Given the majority of hypertension is in the Elderly.
• Will understanding hypertension in the elderly help us
understand hypertension
Hypertension in the elderly
• Pattern of hypertension in this group is characterised by:
• Systolic hypertension.
• Normal or low diastolic pressure.
• Widened pulse pressure.
• Increased pulsatile flow.
Reflects vascular ageing
Vascular Ageing
• Increased arterial stiffness Telomere attrition
• Impaired vasodilation
• Chronic vascular inflammation
• Intimal media thickness and atherosclerosis
• Insulin resistance
• Oxidative stress
• Arterial Calcification
• Small vessel degeneration in brain and kidney
• LVH
• Increased Arterial stiffness is an important phenotype
associated with vascular aging
• As the large conduit arteries stiffen the aortic pulse wave
velocity and pulse pressure increases
• Increased aortic pulse wave velocity results in in early return
of the reflected pressure with augmentation of the systolic
pressure and reduction in diastolic pressure.
• Decreased diastolic pressure futher impairs coronary blood
flow
Treatment options
conclusion
Early vascular aging
• This is the super imposition of a more rapid course of vascular
ageing with atherosclerosis in more susceptible individuals.
• This is measured readily by the use of
• Ultrasound imaging of the arterial wall : carotid , aorta and
Femoral artery
• Physiological
• PWV
CVD
parameters

GFR

Albumin to Creatinine ratio

Carotid to femoral pulse wave velocity

Carotid IMT

LVH

AF
Vascular aging as a marker for CVD

• It is a useful marker to assess cardiovascular

risk in patients
• Especially in patients with marginal risk
• Strong family history of early CVD
manifestation
intimal media thickness

Pulse wave velocity

Central arterial pressure

Vascular changes and Resistant
hypertension
• Blood pressure ≤ 140/90mmHg despite the use of 3
antihypertensives one of which is a diuretic or 4 classes of
antihypertensives regardless of blood pressure.
• Resistant hypertension accounted for 11% of hypertension in
a brazillian study(2014)( blood pressure
• Resistant hypertension was found in 1.Older 2. blacks 3. less
educated,
jul252012115241.wmv
jul252012110724.wmv
ADAM(Aggressive decrease of
atherosclerotic modifiers.
• Treat promoters
• Hypertension
• Hyperlipidaemia
• Impaired Glucose tolerance and type 2 diabetes
• Smoking (vascular dysfunction and I creased insulin
resistance ( interheart study)
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English-speaking West Africa |
28

Corporate Profile
CONCLUSION
• Systolic hypertension is a manifestation of vascular ageing and
accounts for most hypertension
• Increased pulse pressure with ageing is primarily driven by age
–related rise in systolic pressure
• Systolic pressure is an important factor driving an increase in
CV events
• Early markers of CVD like the PWV , IMT should be assessed in
susceptible individuals and treated.
• Vascular ageing is an important cause of systolic hypertension
in the elderly and the role of early vascular ageing in the
younger age group cannot be undermined