PATHOPHYSIOLOGY AND END-ORGAN DAMAGE IN ELDERLY HYPERTENSIVES

Pathophysiology of hypertension: Blood pressure increases with advanci ng age in most developed countries. the pathophysiology of elderly hyp ertension is characterized by changes in the structure and function of the cardiovascular system. Changes in arterial structure lead to a de crease in aortic compliance, which augments the aortic pressure compon ent generated by the wave reflection mechanism. The age-related increa se in the reflected-wave component of arterial pressure may contribute , at least in part, to the age-related rise in systolic blood pressure . Disproportionately elevated systolic blood pressure in the elderly m ay account for the progressive increase in left ventricular mass with advancing age. In addition to the changes in vascular and cardiac stru ctures, the haemodynamic function of elderly hypertensives is characte rized by increased peripheral resistance as well as reduced cardiac ou tput, renal blood flow and intravascular volume. In contrast to younge r hypertensives, the sympathetic and renin-angiotensin systems may not be major factors in the genesis of high peripheral resistance in this patient group. End-organ damage: The most important end-organ damage in elderly hypertensives is left ventricular hypertrophy with or witho ut coronary heart disease, cerebrovascular disease or renal impairment . Furthermore, this end-organ damage is frequently asymptomatic (silen t). the prevalence of silent cerebrovascular disease in particular is surprisingly high in this elderly population. Asymptomatic cerebrovasc ular disease has been shown to be associated with various cardiovascul ar risk factors, and depressed neurobehavioural function. Diurnal bloo d pressure variations appear to be related to end-organ damage. The pr esence of occult end-organ damage and co-existing diseases common in e lderly hypertensives has important clinical implications in the manage ment of this disorder.