THE HEART IN THE HYPERTENSIVE ELDERLY

Left ventricular (LV) mass progressively increases throughout life, re aching its greatest magnitude in senescence. In the normotensive elder ly, left ventricular hypertrophy (LVH) is mostly a consequence of a de generative process in connective tissue, In hypertensive patients, LVH results from an increase in muscle mass and fibrotic tissue. LVH by e chocardiographic criteria can be found in up to 50% of elderly patient s with hypertension. Although associated with aging, LVH is associated with a higher rate of non-fatal and fatal cardiovascular events, Even in the absence of coronary stenosis, LVH is associated with reduced c oronary reserve, increased number of arrhythmias and progressive deter ioration in LV function. Conceivably, an increase in interstitial fibr osis and cross-linking collagen in the senescent heart is responsible for an increase in myocardial stiffness and diastolic abnormalities. R egression of LVH has been demonstrated not only to improve left ventri cular filling and coronary reserve but also to diminish cardiac arrhyt hmias, Although few studies have demonstrated that the reduction of LV mass is associated with better cardiovascular prognosis, it seems rea sonable to consider it a goal of antihypertensive therapy. Of all anti hypertensive agents, angiotensin-converting-enzyme inhibitors seem to be the most powerful in reducing LV mass.