Hypertensive Target-Organ Damage in the Very Elderly

Abstract

Abstract-In people aged Ͼ80 years, the so-called very elderly, there is uncertainty about the relation between hypertension and cardiovascular morbidity. The aims of this study were to investigate whether hypertension in people aged Ͼ80 years is associated with target-organ damage, over and above the effects of age, and to determine whether ambulatory blood pressure monitoring (ABPM) could improve on conventional blood pressure monitoring (CBPM) in predicting target-organ damage. Investigations included echocardiographic measurement of left ventricular mass index (LVMI), brain magnetic resonance imaging assessment of periventricular hyperintensity (PVH), urinary albumin-creatinine ratio (ACR), aortic pulse wave velocity (PWV), and 24-hour ABPM. Forty-three subjects, at a mean age 84.3 years, were studied, 22 normotensive (NT) and 21 hypertensive (HT). CBP was 184/89 and 145/76 mm Hg in the HT and NT groups, respectively. In men, LVMI was significantly greater in HT subjects, 157Ϯ37 vs 123Ϯ15 g/m 2 in NT subjects (PϽ0.05). In women, LVMI was similar in both groups. Urinary ACR was greater in HT than in NT subjects (log ACR, 1.21Ϯ0.50 vs 0.95Ϯ0.23; PϽ0.05). Cerebral PVH grade was higher in the HT subjects (2.6Ϯ0.8 vs 2.2Ϯ0.9), although this difference was not significant. Aortic PWV did not differ between the 2 groups. ABPM was positively associated with urinary ACR and cerebral PVH, independent of its correlation with CBPM. In advanced old age, HT is associated with evidence of target-organ damage. ABPM can improve on CBPM in predicting very elderly subjects with HT target-organ damage.

Ambulatory blood pressure variability and brachial–ankle pulse wave velocity in untreated hypertensive patients

“…Neither the clinic BP nor ambulatory BP of hypertensive patients aged 480 years was associated with PWV; 12 however, we clearly demonstrated a significant correlation between both clinic BP and ambulatory BP and baPWV in untreated hypertensive patients 30 to 75 years of age. Although age and BP are two of the most important determinants of arterial wall stiffness assessed by PWV, 33 age-related arterial changes, such as calcification and loss of elastic tissue in the medial layer, may be the dominant influence on large-artery flexibility beyond high arterial pressure and its variability.…”

“…[7][8][9][10][11] However, a recent study found no correlation between aortic baPWV and mean 24-h ambulatory BP in hypertensive patients, even though they were 80 years of age or older. 12 The BP variability is estimated as the standard deviation of beat-to-beat BP obtained by intraarterial BP monitoring 13,14 or the standard deviation of non-invasively monitored ambulatory BP, [15][16][17] and it is associated with the severity of organ damage and cardiovascular morbidity and mortality in hypertensive patients and the general population. These findings suggest that BP variability determined by 24-h ambulatory BP monitoring may have an impact on baPWV values.…”

Telmisartan Decreases Plasma Levels of Asymmetrical Dimethyl-L-Arginine and Improves Lipid and Glucose Metabolism and Vascular Function

“…The PWV is reportedly decreased by about 10-fold of the rate of the decrease in mean blood pressure, that is, approximately 0.7-fold as the rate of change. 27) In the present study, the rate of change of the mean blood pressure was 16%, whereas that in PWV was 8.8%. Therefore, the improvement was not favorable; however, in elderly patients, the influence of blood pressure may be less marked than in young patients due to the reduction of elastic vascular function.…”

“…A previous study investigated organ disorders in persons aged over 80 years, and reported that there was no difference in PWV between normal and hypertensive subjects. 27) As the present study included many elderly patients, the relatively short time results of improvement of atherosclerosis in these patients may be useful in clinical practice.…”

Hypertensive Intracerebral Hemorrhage in the Very Elderly

“…This finding suggests that the parenchymal degeneration observed with the aging process is an important factor that may contribute to the more catastrophic effect of ICH in the very elderly people [12, 13,21,22,23,24]. We have hypothesized that the aging process may imply changes in brain plasticity, a factor that may cause a decline in the strength of the brain tissue normally acting as a restriction wall to the extension of the hematoma [13].…”