Hypertension in the Elderly

  • Franz H. Messerli
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 31)


The widespread confusion with regard to definition, evaluation, treatment, and prognosis of high blood pressure in the elderly may result from several of the following facts. First, since blood pressure increases with age in the general population, an elevated arterial pressure is felt to represent a normal finding in the elderly. Second, the elderly patients predominantly present with systolic hypertension, and it is felt that only diastolic hypertension increases morbidity and mortality. Third, since perfusion of various vital organs diminishes with aging because of arteriosclerosis, it is felt that an increase in arterial pressure represents a compensatory process to maintain an adequate organ blood supply (requisiteness-hypertension). Finally, no data have been provided to show that hypertension in the elderly is a separate entity that requires a different approach from that commonly used in the young and middle-aged patient.


Arterial Pressure High Blood Pressure Left Ventricular Hypertrophy Orthostatic Hypotension Plasma Renin Activity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Messerli FH, Ventura HO, Glade LB, Sundsaard-Riise K, Dunn FG, Frohlich ED. Essential hypertension in the elderly: haemodynamics, intravascular volume, plasma renin activity, and circulating catecholamine levels. Lancet Vol. II, #8357: 983–985, 1983.Google Scholar
  2. 2.
    Ostfeld AM. Elderly hypertensive patient: Epidemiologic review. NY State J Med 78: 1125 1129, 1978.Google Scholar
  3. 3.
    Ostfeld AM, Shekelle RB, Klawans H, and Tufo HM. Epidemiology of stroke in an elderly welfare population. Am J Pub Health 64: 450–458, 1974.CrossRefGoogle Scholar
  4. 4.
    Kannel WB and Gordon T. Evaluation of cardiovascular risk in the elderly: The Framingham study. Bull N Y Acad Med 54: 573–591, 1978.PubMedGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    Kuramoto K, Matsushita S, Kuwajima I, and Murakami M. Prospective study on the treatment of mild hypertension in the aged. Jpn Heart J 22: 75–85, 1981.PubMedCrossRefGoogle Scholar
  7. 7.
    Hypertension-Stroke Cooperative Study Group. Effect of antihypertensive treatment on stroke recurrence. JAMA 229: 409–418, 1974.CrossRefGoogle Scholar
  8. 8.
    Hypertension Detection and Follow-Up Program Cooperative Group. Five-year findings of the HDFP: II. Mortality by race, sex, and age. JAMA 242: 2572–2577, 1979.CrossRefGoogle Scholar
  9. 9.
    Brandfonbrener M, Landowne M, and Shock NW. Changes in cardiac output with age. Circulation 12: 557–566, 1955.PubMedCrossRefGoogle Scholar
  10. 10.
    Standell T. Circulatory studies on healthy old men. Acta Med Scan 175 (Suppl 414): 1–44, 1964.Google Scholar
  11. 11.
    Conway J, Wheeler R, and Sannerstedt R. Sympathetic nervous activity during exercise in relation to age. Cardiovas Res 5: 577–581, 1971.CrossRefGoogle Scholar
  12. 12.
    Julius S, Antoon A, Whitlock LS, and Conway J. Influence of age on the hemodynamic response to exercise. Circulation 36: 222–230, 1967.PubMedCrossRefGoogle Scholar
  13. 13.
    Messerli FH, Frohlich ED, Suarez DH, Reisin E, Dreslinski GR, Dunn FG, and Cole FE. Borderline hypertension: Relationship between age, hemodynamics and circulating catecholamines. Circulation 64: 760–764, 1981.PubMedCrossRefGoogle Scholar
  14. 14.
    Gerstenblith G, Weisfeldt ML, and Lakatta EG. Age changes in myocardial function and exercise response. Prog Cardiovasc Dis 19: 1–21, 1976.PubMedCrossRefGoogle Scholar
  15. 15.
    Sjogren AL. Left ventricular wall thickness determined by ultrasound in 100 subjects without heart disease. Chest 60: 341–346, 1971.PubMedCrossRefGoogle Scholar
  16. 16.
    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
  17. 17.
    Messerli FH. Clinical determinants and consequences of left ventricular hypertrophy. Proceedings of a Symposium: Left ventricular Hypertrophy in Essential Hypertension Sept 1983.Google Scholar
  18. 18.
    Hollenberg NK, Adams DF, Solomon HS, Rshid A, Abrams HL, and Merrill JP. Senesence and the renal vasculature in normal man. Circ Res 34: 309–316, 1974.PubMedCrossRefGoogle Scholar
  19. 19.
    Chien S, Usami S, Simmons RL, McAllister FF, and Gregersen MI. Blood volume and age: Repeated measurements on normal men after 17 years. Appl Physiol 21: 583–588, 1966.Google Scholar
  20. 20.
    Niarchos AP. Pathophysiology, diagnosis and treatment of hypertension in the elderly. Cardiovascular Reviews and Reports 1 (8): 621–627, 1980.Google Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    Dzau VJ, Colucci WS, Hollenberg NK, and Williams GH. Relationship of renin angiotensin aldosterone system to clinical state in congestive heart failure. Circulation 63 (3): 645–651, 1981.PubMedCrossRefGoogle Scholar
  23. 23.
    Spence JD, Sibblad WJ, and Cape RD. Pseudohypertension in the elderly. Clin Sci Mol Med 55 (suppl 4): 399s - 402s, 1978.Google Scholar
  24. 24.
    Delin K, Aurell M, Granerus G, Holm J, and Schersten T. Surgical treatment of renovascular hypertension in the elderly patient. Acta Med Scand 211: 169–174, 1982.PubMedCrossRefGoogle Scholar
  25. 25.
    Greenblatt DJ, Sellers EM, and Shader RI. Drug disposition in old age. N Engl J Med 306: 1081–1088, 1982.PubMedCrossRefGoogle Scholar
  26. 26.
    Jick H, Slone D, Borda IT, and Shapiro S. Efficacy and toxicity of heparin in relation to age and sex. N Engl J Med 279: 284–286, 1968.PubMedCrossRefGoogle Scholar
  27. 27.
    Reidenberg MM, Levy M, Warner H, Coutinho CB, Schwartz MA, Yu G, and Cheripko J. Relationship between diazepam dose, plasma level, age and central nervous system depression. Clin Pharmacol Ther 23: 371–374, 1978.PubMedGoogle Scholar
  28. 28.
    Vestal RE, Wood AJ, and Shand DG. Reduced beta-adreno-receptor sensitivity in the elderly. Clin Pharmacol Ther 26: 181–186, 1979.PubMedGoogle Scholar
  29. 29.
    Jackson G, Pierscianowski TA, Mahon W, and Condon). Inappropirate hypertensive therapy in the elderly. Lancet 2: 1317, 1976.PubMedCrossRefGoogle Scholar
  30. 30.
    Ruff RL, Talman WT, and Petito F. Transient ischemic attacks associated with hypotension in hypertensive patients with carotid artery stenosis. Stroke 12: 353–355, 1981.PubMedCrossRefGoogle Scholar
  31. 31.
    Kennedy RM and Earley LE. Profound hyponatremia resulting from a thiazide-induced decrease in urinary diluting capacity in a patient with primary polydipsia. N Engl J Med 282: 1185–1186, 1970.PubMedCrossRefGoogle Scholar
  32. 32.
    Castleden CM and George C. The effect of ageing on hepatic clearance of propranolol. Br J Clin Pharmacol 7: 49–54, 1979.PubMedCrossRefGoogle Scholar
  33. 33.
    Messerli FH, Dreslinski GR, Husserl FE, Suarez DH, MacPhee AA, Frohlich ED: AntiAdrenergic therapy of hypertension in the elderly. Hypertension 3 (suppl II): II-226–229, 1981.Google Scholar
  34. 34.
    Fouad FM, Nakashima Y, Tarazi RC, and Salcedo EE. Reversal of left ventricular hypertrophy in hypertensive patients treated with methyldopa: Lack of association with blood pressure control. Am J Cardiol 49: 795–801, 1982.PubMedCrossRefGoogle Scholar
  35. 35.
    Messerli FH and Ventura HO. Calcium antagonists in arterial hypertension. Drug Therapy, November 1982, pp 39–44.Google Scholar
  36. 36.
    Messerli FH and Frohlich ED. High blood pressure: A common side effect of drugs, poisons, and food. Arch Intern Med 139: 682–687, 1979.PubMedCrossRefGoogle Scholar

Suggested Reading

  1. Amery A, Hansson L, Andren L, Gudbrandsson T, Sivertsson R, and Syensson A. Hypertension in the elderly. Acta Med Scand 210: 221–229, 1981.PubMedCrossRefGoogle Scholar
  2. O’Malley K and O’Brien E. Management of hypertension in the elderly. N Engl J Med 302 (25): 1397–1401, 1980.PubMedCrossRefGoogle Scholar
  3. Wood AJJ and Feely J. Management of hypertension in the elderly. South Med J 74(12):15031508, 1981.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1984

Authors and Affiliations

  • Franz H. Messerli

There are no affiliations available

Personalised recommendations