Hypertension in the elderly is a problem of particular clinical relevance. In fact, cardiovascular morbility and mortality, that is the incidence of coronopathy, cerebrovascular disease, congestive heart failure and renal failure, are not only related to the values of blood pressure, but this relationship persists with aging. In the elderly, vascular lesions come from the paraphysiological aging alterations and the development of atherosclerosis, and they lead to the onset and maintenance of increased blood pressure values. Nephrovascular hypertension is one of the most important causes of secondary hypertension in the elderly, and generally it has atherosclerosis origin. It is suspected when increased blood pressure values develop suddenly after the age of 50-60 years, in presence of smoking, atherosclerotic diseases and fast worsening of renal function indices after ACE-inhibitor treatment. Pharmacology (calcium-antagonist, beta-blockers) and surgery (angioplasty, renal artery by-pass) give the possibility to prevent renal damage induced by sustained hypertension. With aging there is a progressive decrease of arterial elastic properties. A study on arterial compliance alterations in elderly patients with isolated systolic hypertension (one of the most common type of hypertension in this group of people) or sisto-diastolic hypertension showed that: 1) there is a striking relationship between hypertension and structural and functional alterations of arterial wall in these patients; 2) functional alterations of arterial wall are more evident in patients with isolated systolic hypertension, both at the muscular and the elastic arteries; 3) the mechanisms responsible for the functional alterations of the radial artery, a muscle type artery, should come from qualitative changes of wall artery composition, that is more wall collagen content in the essential hypertension and the hyperplasia- hypertrophy of wall smooth muscle cells in the systo-diastolic hypertension. A further worsening of blood pressure value control may derive by the concomitant presence of other risk factors like smoking and hyper- cholesterolemia.
|Translated title of the contribution||Hypertension in the elderly: Physiopathological, clinical and therapeutical aspects|
|Number of pages||9|
|Publication status||Published - 1997|
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