Document Detail

Pathophysiology of hypertension in older patients.
MedLine Citation:
PMID:  3048095     Owner:  NLM     Status:  MEDLINE    
More than half of the United States population over 65 years of age has essential hypertension. In 1984, there were 10 million elderly hypertensive persons and this number will reach 25 million in the near future. These patients are at high risk for congestive heart failure, stroke, heart attack, and dissecting aneurysm. Successful reduction of blood pressure can lower these risks considerably, but rational treatment depends on understanding the complex pathophysiology of hypertension in older patients. In fact, treatment that does not take into account the combined effects of aging and hypertension on the cardiovascular system and the kidneys may do more harm than the hypertension itself. Among the prominent age-related cardiovascular changes are stiffening of the arterial tree, with or without a contribution from atherosclerosis. This reduces arterial compliance and increases afterload, resulting in the left-ventricular hypertrophy seen in old age and leading to a progressive rise in systolic pressure. There is considerable shrinkage of the kidneys, due primarily to loss of glomerular and tubular tissue in the cortex, along with sclerosis of the glomeruli and formation of tubular diverticula. Arteriolar changes lead to reduced renal blood flow, the shunting of blood around the glomeruli, and thus a reduction in glomerular filtration rate. Renal water and electrolyte excretion are changed, making homeostasis more difficult to maintain, and the renin-angiotensin system is altered, helping to blunt the kidneys' response to pressure changes. Essential hypertension superimposed on all the foregoing effects exacerbates them. Peripheral resistance is usually markedly elevated in older hypertensive persons, which increases afterload directly.(ABSTRACT TRUNCATED AT 250 WORDS)
W B Abrams
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The American journal of medicine     Volume:  85     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  1988 Sep 
Date Detail:
Created Date:  1988-10-27     Completed Date:  1988-10-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  7-13     Citation Subset:  AIM; IM    
Merck Sharp & Dohme Research Laboratories, West Point, Pennsylvania 19486.
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MeSH Terms
Age Factors
Aging / physiology
Cardiovascular Diseases / etiology
Hypertension / complications,  epidemiology,  physiopathology*
Kidney / physiopathology
Middle Aged
Renin-Angiotensin System
Risk Factors
Sex Factors
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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