Antihypertensive treatment and cerebral circulation in the elderly

A. Postiglione, A. Soricelli, S. De Chiara, A. Brunetti

Research output: Contribution to journalArticle

Abstract

Hypertension is a major risk factor for stroke, coronary heart disease and congestive heart failure for patients at all ages. In patients with chronic hypertension and without neurological deficits cerebral blood flow (CBF) is normal, but both lower and upper limits of CBF autoregulation are shifted towards higher values, probably due to functional and morphological changes of arterial vessels. An increased lower limit of autoregulation means that long-standing hypertensive patients have a major risk to develop symptoms of cerebral ischemia when an overzealous antihypertensive treatment is applied. This is particularly evident in the elderly, where disturbances of cerebral circulation may occur even at very low reduction of blood pressure (BP). As a matter of fact, the baroreflex is less sensitive in older ages and a rapid decrease in BP could not be compensated as promptly as in the young ones. Cerebral autoregulation could be impaired and CBF is usually lower as compared to that of young subjects. Finally, there is a high frequency of in-flow artery stenosis with exhausted mechanisms of compensation. Therefore particular attention should be devoted to the choice of antihypertensive drugs to be used (e.g., drugs causing postural hypotension should be avoided) and to what extent BP should be lowered. Among antihypertensive compounds, angiotensin-converting enzyme (ACE) inhibitors appear to have a protective action on CBF autoregulation and are particularly useful in elderly patients, especially in those suffering from congestive heart failure.

Original languageEnglish
Pages (from-to)425-432
Number of pages8
JournalArchives of Gerontology and Geriatrics
Volume12
Issue numberSUPPL. 2
Publication statusPublished - 1991

Keywords

  • ACE inhibitors
  • cerebral blood flow
  • cerebral blood flow autoregulation
  • hypertension

ASJC Scopus subject areas

  • Ageing
  • Medicine(all)

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    Postiglione, A., Soricelli, A., De Chiara, S., & Brunetti, A. (1991). Antihypertensive treatment and cerebral circulation in the elderly. Archives of Gerontology and Geriatrics, 12(SUPPL. 2), 425-432.