Skip to main content
SpringerLink
Log in

Essential Hypertension in the Elderly

  • Chapter
Cardiovascular Disease in the Elderly

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 76))

  • 45 Accesses

Abstract

Despite several recent review articles, there is still widespread confusion regarding the definition, evaluation, treatment, and prognosis of essential hypertension in patients older than 65 years [2–7]. Several misconceptions may contribute to this disarray. First, arterial pressure increases with age in Westernized populations, and therefore an elevated pressure is thought to be a normal finding in the elderly population. Second, function and perfusion of vital organs diminish with age, and an elevated pressure is regarded as a physiologic compensatory process serving to restore or maintain adequate blood flow. Third, elderly patients with essential hypertension have predominately systolic hypertension, and many physicians believe that only diastolic hypertension is a harbinger of heart attack, stroke, and death. Fourth, only few data have been published indicating that mechanisms of pressure elevation differ between the older and the younger patient with established essential hypertension.

Part of this manuscript and figures were taken from a publication from the Hypertension Update II Symposium, Washington, D.C., June 1984, with permission from Health Learning Systems, Inc. [1].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Messerli FH. Hypertension Update II Symposium. Washington D.C.: Health Learning Systems, 1985.

    Google Scholar 

  2. Gavras H and Gavras I (eds). Hypertension in the Elderly. Boston: John Wright Publishers, 1983.

    Google Scholar 

  3. Kaplan NN. Hypertension in patients over 65. Consultant, May 1980, pp 210–217.

    Google Scholar 

  4. Kirkendall WM and Hammond JJ. Hypertension in the elderly. Arch Intern Med 140:1155–1161, 1980.

    Article  PubMed  CAS  Google Scholar 

  5. Messerli FH. Hypertension in the elderly. In FH Messerli (ed), Cardiovascular Disease in the Elderly. Boston: Martinus Nijhoff Publishing, 1984, pp 65–81.

    Chapter  Google Scholar 

  6. Niarchos A and Laragh JH. Hypertension in the elderly. Part 1, pathophysiology; part 2, diagnosis and treatment. Modern Concepts of Cardiovascular Disease 49(8):43–48, 1980.

    PubMed  CAS  Google Scholar 

  7. Ostfeld AM. Early hypertensive patient: Epidemiological review. NY State J Med 78:1125–1129, 1978.

    Google Scholar 

  8. Messerli FH. Essential hypertension in the elderly: Haemodynamics, intravascular volume, plasma renin activity, and circulating catecholamine levels. Lancet 2:983–986, 1983.

    Article  PubMed  CAS  Google Scholar 

  9. National Health Survey. Vital and Health Statistics USA: Blood Pressure of Adults by Age and Sex. Washington, D.C.: U.S. Government Printing Office, 1964, p 9.

    Google Scholar 

  10. National Health Survey. Vital and Health Statistics Series 11, No. 150. Blood Pressure of persons 18 to 74 years, United States, 1971–72, U.S. Department of Health, Education and Welfare, Bethesda, Maryland, 1975.

    Google Scholar 

  11. Friesf F. Aging, natural death, and the compression of morbidity. N Engl J Med 303:130–135, 1980.

    Article  Google Scholar 

  12. Veterans Administration Cooperative Study Group on Antihypertensive Agents. III. Chlorothiazide alone and in combination with other agents. Arch Intern Med 110:230–236, 1962.

    Article  Google Scholar 

  13. Kannel WB and Gordon T. Evaluation of cardiovascular risk in the elderly: The Framingham study. Bull NY Acad Med 54:573–591, 1978.

    CAS  Google Scholar 

  14. Shekelle RB, Ostfeld AM, -and Klawans HF Jr. Hypertension and risk of stroke in an elderly population. Stroke 5:71–75, 1974.

    Article  PubMed  CAS  Google Scholar 

  15. Forette F, Henry JF, Forette B, and Berthaux P. Hypertension arterielle du sujet age prevalence en milieu long sejour. Nouv Presse Med 4:2997–2998, 1975.

    PubMed  CAS  Google Scholar 

  16. Svardsudd K and Tibblin G. Mortality and morbidity during 13.5 years’ follow up in relation to blood pressure. Acta Med Scand 205:483–484, 1979.

    Article  PubMed  CAS  Google Scholar 

  17. Kannel WB, Wolf PA, McGee DL, et al. Systolic blood pressure, arterial rigidity, and risk of stroke: The Framingham study. JAMA 245:1225–1229, 1981.

    Article  PubMed  CAS  Google Scholar 

  18. Amery A, Brixko P, Clement D, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet 1:1349–1354, 1985.

    Article  PubMed  CAS  Google Scholar 

  19. Australian therapeutic trial in mild hypertension. Report by the Management Committee. Lancet 1:1261–1267, 1980.

    Google Scholar 

  20. Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of HDFP: II. Mortality by race, sex, and age. JAMA 242:2572–2577, 1979.

    Article  Google Scholar 

  21. Hypertension-Stroke Cooperative Study Group. Effect of antihypertensive treatment on stroke recurrence. JAMA 229:409–418, 1974.

    Article  Google Scholar 

  22. Kuramoto K, Matsushita S, Kuwajima I, and Murakamu M. Prospective study on the treatment of mild hypertension in the aged. Jpn Heart J 22:75–85, 1981.

    Article  PubMed  CAS  Google Scholar 

  23. Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effect of treatment on morbidity in hypertension: III. Influence of age, diastolic pressure, and prior cardiovascular disease. Circulation 45:991–1004, 1972.

    Article  Google Scholar 

  24. Hollifield JW, Moore LC, Winn SP, and Slaton PE. The role of magnesium, potassium, and beta adrenergic agonists in ventricular arrhythmias associated with hydrochlorothiazide therapy in hypertension (abstract). Circulation 68(suppl III):III-92, 1983.

    Google Scholar 

  25. Lund-Johansen P. Hemodynamic response: Decrease in cardiac output vs reduction in vascular resistance. Hypertension 5:III 49–57, 1983.

    Google Scholar 

  26. Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 248:1465–1477, 1982.

    Article  Google Scholar 

  27. Weidmann P, Gerber A, and Mordäsini R. Effects of antihypertensive therapy on serum lipoproteins. Hypertension 5:III 120–131, 1983.

    Google Scholar 

  28. Bühler FR. Age and cardiovascular response adaptation: Determinants of an antihypertensive treatment concept primarily based on beta-blockers and calcium entry blockers. Hypertension 5:III–94–100, 1983.

    Google Scholar 

  29. Messerli FH. Management of hypertension in the elderly. Curr Med Res Opin 8(suppl 1):30–38, 1982.

    Article  Google Scholar 

  30. Terasawa F, Kuramoto K, Ying LH, et al. The study on the haemodynamics in old hypertensive subjects. Acta Gerontol Jpn 56:47–55, 1972.

    Google Scholar 

  31. Messerli FH. Essential hypertension in the elderly. Triangle 24:35–47, 1985.

    Google Scholar 

  32. Lund-Johansen P. Heart pump function and total peripheral resistance in mild essential hypertension: A 17-year follow-up study. In B Folkow, M Nordlander, BE Strauer, et al. (eds), Hypertension: Pathophysiology and Clinical Implications of Early Structural Changes. Molndal, Sweden, Hassle, 1985, pp 392–407.

    Google Scholar 

  33. Brandfonbrener M, Landowne M, and Shock NW. Changes in cardiac output with age. Circulation 12:557–566, 1955.

    Article  PubMed  CAS  Google Scholar 

  34. Conway J, Wheeler R, and Sannerstedt R. Sympathetic nervous activity during exercise in relation to age. Cardiovasc Res 5:577–581, 1971.

    Article  PubMed  CAS  Google Scholar 

  35. Julius S, Antoon A, Whitlock LS, and Conway J. Influence of age on the hemodynamic response to exercise. Circulation 36:222–230, 1967.

    Article  PubMed  CAS  Google Scholar 

  36. Messerli FH, Frohlich ED, Suarez DH, et al. Borderline hypertension: Relationship between age, hemodynamics, and circulating catecholamines. Circulation 64:760–764, 1981.

    Article  PubMed  CAS  Google Scholar 

  37. Standell T. Circulatory studies on healthy old men. Acta Med Scand 175(suppl 414):1–44, 1964.

    Google Scholar 

  38. Fleg JL, Gerstenblith G, and Lakatta EG. Pathophysiology of the aging heart and circulation. In FH Messerli (ed), Cardiovascular Disease in the Elderly. Boston: Martinus Nijoff, 1984, pp 11–34.

    Chapter  Google Scholar 

  39. Rodeheffer RJ, Gerstenblith G, Becker LC, et al. Exercise cardiac output is maintained in advancing age of healthy human subjects: Cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation 69:203–213, 1984.

    Article  PubMed  CAS  Google Scholar 

  40. Messerli FH. Individualization of antihypertensive therapy: An approach based on hemodynamics and age. J Clin Pharmacol 21:517–528, 1981.

    Article  PubMed  CAS  Google Scholar 

  41. Fries ED. Hemodynamics of hypertension. Physiol Rev 40:27–54, 1960.

    Google Scholar 

  42. Messerli FH. Clinical determinants and consequences of left ventricular hypertrophy. Am J Med 75:51–63, 1983.

    Article  PubMed  CAS  Google Scholar 

  43. Gardin JM, Henry WL, Savage DP, and Epstein SE. Echocardiographic evaluation of an older population without clinically apparent heart disease (abstract). Am J Cardiol 39:277, 1977.

    Google Scholar 

  44. Gerstenblith G, Weisfeldt ML, and Lakatta EG. Age changes in myocardial function and exercise response. Prog Cardiovasc Dis 19:1–21, 1976.

    Article  PubMed  CAS  Google Scholar 

  45. Sjogren AL. Left ventricular wall thickness determined by ultrasound in 100 subjects without heart disease. Chest 60:341–346, 1971.

    Article  PubMed  CAS  Google Scholar 

  46. Messerli FH, Sundgaard-Riise K, Ventura HO, et al. Clinical and hemodynamic determinants of left ventricular function and structure. Arch Intern Med 144:477–481, 1984.

    Article  PubMed  CAS  Google Scholar 

  47. Kannel WB. Prevalence and natural history of electrocardiographic left ventricular hypertrophy. In FH Messerli and RC Schlant (eds), Proceedings of a Symposium: Left Ventricular Hypertrophy in Essential Hypertension. Am J Med 75(suppl 3A):53, 1983.

    Google Scholar 

  48. Kannel WB, Gordon T, and Offutt D. Left ventricular hypertrophy by electrocardiogram: Prevalence, incidence, and mortality in the Framingham study. Ann Intern Med 71:89–105, 1969.

    Article  PubMed  CAS  Google Scholar 

  49. Kannel WB. Prevalence and natural history of electrocardiographic left ventricular hypertrophy. In FH Messerli and RC Schlant (eds), Proceedings of a Symposium: Left Ventricular Hypertrophy in Essential Hypertension. Am J Med 76:4–11, 1983.

    Google Scholar 

  50. Messerli FH, Ventura HO, Elizardi DJ, et al. Hypertension and sudden death: Increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med 77:18–22, 1984.

    Article  PubMed  CAS  Google Scholar 

  51. Shannon RP, Wei JY, Rosa RM, et al. The effect of age and sodium depletion on cardiovascular response to orthostasis. Hypertension 8:438–444, 1986.

    Article  PubMed  CAS  Google Scholar 

  52. Hollenberg NK, Epstein M, Basch RI, et al. “No man’s land” of the renal vasculature. An arteriographic and hemodynamic assessment of the interlobar and arcuate arteries in essential and accelerated hypertension. Am J Med 47:845–855, 1969.

    Article  PubMed  CAS  Google Scholar 

  53. Hollenberg NK and Adams DF. The renal circulation in hypertensive disease. Am J Med 60:773–784, 1976.

    Article  PubMed  CAS  Google Scholar 

  54. Reubi FC, Weidmann P, Hodler J, and Cottier PT. Changes in renal function in essential hypertension. Am J Med 64:556–563, 1978.

    Article  PubMed  CAS  Google Scholar 

  55. Messerli FH, Dreslinski GR, and Frohlich ED. Serum uric acid in essential hypertension: An indicator of renal vascular involvement. Ann Intern Med 93:817–821, 1980.

    Article  PubMed  CAS  Google Scholar 

  56. Chien S, Usami S, Simmons RL, et al. Blood volume and age: Repeated measurements on normal men after 17 years. Appl Physiol 21:583–588, 1966.

    CAS  Google Scholar 

  57. Crane MG, Harris JJ, and Johns VJ. Hyporeninemic hypertension. Am J Med 52:457–466, 1972.

    Article  PubMed  CAS  Google Scholar 

  58. Flood C, Gherondache C, Pinus C, et al. The metabolism and secretion of aldosterone in elderly subjects. J Clin Invest 46:960–966, 1967.

    Article  PubMed  CAS  Google Scholar 

  59. Jose A, Crout R, and Kaplan NM. Suppressed plasma renin activity in essential hypertension: Roles of plasma volume, blood pressure, and sympathetic nervous system. Ann Intern Med 72:9–16, 1970.

    Article  PubMed  CAS  Google Scholar 

  60. Lijnen PJ, Kamery AK, Fagard RH, and Reybrouck TM. Relative significance of plasma renin activity and concentration in physiologic and pathophysiologic conditions. Angiology 29:354–366, 1978.

    Article  PubMed  CAS  Google Scholar 

  61. Meade TW, Imeson JD, Gordon D, and Peart WS. The epidemiology of plasma renin. Clin Sci 64:273–280, 1983.

    PubMed  CAS  Google Scholar 

  62. Weidmann P, De Myttenaere-Bursztein S, Maxwell MH, and Lima JD. Effect of aging on plasma renin and aldosterone in normal man. Kidney Int 8:325–333, 1975.

    Article  PubMed  CAS  Google Scholar 

  63. Dzau VJ, Colucci WS, Hollenberg NK, and Williams GH. Relationship of renin angiotensin aldosterone system to clinical state in congestive heart failure. Circulation 63:645–651, 1981.

    Article  PubMed  CAS  Google Scholar 

  64. Franco-Morselli R, Elghozi JL, Jolly E, et al. Increased plasma adrenaline concentrations in benign essential hypertension. Br Med J 2:1251–1254, 1977.

    Article  PubMed  CAS  Google Scholar 

  65. Goldstein DS. Plasma catecholamines and essential hypertension: An analytical review. Hypertension 5:86–99, 1983.

    Article  PubMed  CAS  Google Scholar 

  66. Lake CR, Ziegler MG, Coleman MD, and Kopin IJ. Age-adjusted plasma norepinephrine levels are similar in normotensive and hypertensive subjects. N Engl J Med 296:208–209, 1977.

    Article  PubMed  CAS  Google Scholar 

  67. Cohn JN, Levine TB, Olivari MT, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 311:819–823, 1984.

    Article  PubMed  CAS  Google Scholar 

  68. Bertel O, Buhler FR, Kiowski W, and Lutold BE. Decreased beta-adreno-receptor responsiveness as related to age, blood pressure and plasma catecholamines in patients with essential hypertension. Hypertension 2:130–138, 1980.

    Article  PubMed  CAS  Google Scholar 

  69. Van Brummelen P, Buhler FR, Kiowski W, and Amann FW. Age-related decrease in cardiac and peripheral vascular responsiveness to isoprenaline: Studies in normal subjects. Clin Sci 60:571–577, 1981.

    PubMed  Google Scholar 

  70. Vestal RE, Wood JJ, and Shand DG. Reduced beta-adrenoceptor sensitivity in the elderly. Clin Pharmacol 26:181–186, 1979.

    CAS  Google Scholar 

  71. Kelly J and O’Malley K. Adrenoreceptor function and aging. Clin Science 66:509–515, 1984.

    CAS  Google Scholar 

  72. Colandrea MA, Friedman GD, Nichaman MZ, et al. Systolic hypertension in the elderly. Circulation 41:239–245, 1970.

    Article  PubMed  CAS  Google Scholar 

  73. Messerli FH, Ventura HO, Aristimuno GG, et al. Arterial compliance in systolic hypertension. Clin Exp Hypertens A4:1037–1044, 1982.

    Article  Google Scholar 

  74. Vanden Bos GC, Randall OS, and Westerhof N. Blood pressure and cardiac output during decreased arterial compliance. J Physiol 317:68–69, 1981.

    Google Scholar 

  75. Vardan S, Mookherjee S, Warner R, and Smulyan H. Systolic hypertension: Direct and indirect BP measurements. Arch Intern Med 143:935–938, 1983.

    Article  PubMed  CAS  Google Scholar 

  76. Simon AC, Safar ME, Kheder AM, et al. Systolic hypertension: Hemodynamic mechanisms and choice of antihypertensive treatment. Am J Cardiol 45:505–511, 1979.

    Article  Google Scholar 

  77. Osler W. Principles and Practice of Medicine. New York: Appleton, Century, & Croft, 1982.

    Google Scholar 

  78. Spence JD, Sibblad WJ, and Cape RD. Pseudohypertension in the elderly. Clin Sci Mol Med 5(suppl 4):399s-402s, 1978.

    Google Scholar 

  79. Messerli FH, Ventura HO, and Amodeo C. Osler’s maneuver and pseudohypertension. N Engl J Med 312:1548–1551, 1985.

    Article  PubMed  CAS  Google Scholar 

  80. Messerli FH. Cardiovascular effects of obesity and hypertension. Lancet 1:1165–1168, 1982.

    Article  PubMed  CAS  Google Scholar 

  81. Hubert HB, Feinleib M, McNamara PM, and Castelli WP. Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study. Circulation 67:968–977, 1983.

    Article  PubMed  CAS  Google Scholar 

  82. Dustan HP, Tarazi RC, and Bravo EL. Dependence of arterial pressure on intravascular volume in treated hypertensive patients. N Engl J Med 286:861–866, 1972.

    Article  PubMed  CAS  Google Scholar 

  83. Campese VM, Romoff M, Telfer N, et al. Role of sympathetic nerve inhibition and body sodium volume state in the antihypertensive action of clonidine in essential hypertension. Kidney Int 18:351–357, 1980.

    Article  PubMed  CAS  Google Scholar 

  84. Messerli FH, Dreslinski GR, Husserl FE, et al. Antiadrenergic therapy of hypertension in the elderly. Hypertension 3:11–226–229, 1981.

    Google Scholar 

  85. Bühler FR and Hulthen L. Calcium channel blockers: A pathophysiologically based antihypertensive treatment concept for the future? Europ J Clin Invest 12:1–3, 1982.

    Article  PubMed  Google Scholar 

  86. Bühler FR, Hulthen UL, Kiowski W, and Bolli P. Beta blockers and calcium antagonists: Cornerstones of antihypertensive therapy in the 1980’s. Drugs 6(suppl 6):9888–9894, 1984.

    Google Scholar 

  87. Henry PD. Atherosclerosis, calcium and calcium antagonists. Circulation 72:456–459, 1985.

    Article  PubMed  CAS  Google Scholar 

  88. Dunn FG, Oigman W, Ventura HO, et al. Enalapril improves systemic and renal hemodynamics and allows regression of left ventricular mass in essential hypertension. Am J Cardiol 53:105–108, 1984.

    Article  PubMed  CAS  Google Scholar 

  89. Tarazi RC, Bravo EL, Fouad FM, et al. Hemodynamic and volume changes associated with captopril. Hypertension 2:576–585, 1980.

    Article  PubMed  CAS  Google Scholar 

  90. Johnson L, Escala EL, Feder J, et al. The hemodynamics of labetalol in hypertensive patients with left ventricular dysfunction and a history of congestive heart failure. Clin Res 32:344A, 1984.

    Google Scholar 

  91. Lund-Johansen P. The effects of beta blocker therapy on chronic hemodynamics. Primary Cardiology 1:20–28, 1980.

    Google Scholar 

  92. Manin’t Veld AJ, Boomsma F, and Schalekamp MA. Effects of beta-adrenoreceptor agonists and antagonists. A clue to the nature of their antihypertensive mechanism. Br J Clin Pharmacol 13(suppl 2):2455–2485.

    Google Scholar 

  93. Grabner W and Weidinger G. Hypertonie und Dehydroergotosin? Med Klin 77, 1982.

    Google Scholar 

  94. Welzel D, Weidinger G, and Koppenhagen K. Zentrale Hamodynamik der Antihypertensiva. Untersuchungen mit Co-Dergocrinmesylat. Dtsch Med Wochenschr 109:1064–1068, 1984.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Franz H. Messerli
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Alton Ochsner Medical Foundation, New Orleans, Louisiana, USA

    Franz H. Messerli

Rights and permissions

Reprints and permissions

Copyright information

© 1987 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Messerli, F.H. (1987). Essential Hypertension in the Elderly. In: Messerli, F.H. (eds) Cardiovascular Disease in the Elderly. Developments in Cardiovascular Medicine, vol 76. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-9925-4_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4684-9925-4_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4684-9927-8

  • Online ISBN: 978-1-4684-9925-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation