Abstract
The population in Asia has been rising since 2000 and is estimated to reach 932 million in 2050, making Asia the most populous elderly region in the world. The prevalence of hypertension is high even in Asia and it rises with age. In tandem with the aging population, Asia will have the largest population with hypertension in the world by the middle of this century.
While several of the mechanisms and pathophysiology responsible for the causation of hypertension are similar to younger adults, many differences also occur. The elderly have more arterial stiffness leading to a greater elevation of systolic blood pressure (BP) than the diastolic BP, resulting in a higher prevalence of isolated systolic hypertension which is more difficult to treat. The elderly is also more salt-sensitive and herein opportunities and evidence exist that lowering salt intake can lower BP. Evidence has also emerged that the white coat effect and masked hypertension are more common in the elderly and should be identified as they are associated with increased cardiovascular (CV) risk.
Hypertension in the elderly needs to be treated as reducing BP reduces CV mortality and morbidity. However, because the elderly is a more vulnerable group, usually having many other co-morbid conditions, including functional and cognitive impairments. Treatment may increase the occurrence of postural hypotension potentially leading to falls; thus, any treatment for the elderly has to be individualized. Target BP control for the elderly has to balance the benefits and adverse effects of anti-hypertensive therapy.
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References
WHO. Ageing and health fact sheet. WHO Publication. 2018. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 9 Aug 2021.
Department of Economic and Social Affairs, Population Division, United Nations. World Population Prospects 2019. https://population.un.org/wpp/. Accessed 9 Aug 2021.
Population and aging in Asia: the growing elderly population. Asia Development Bank. 2018. https://data.adb.org/dataset/population-and-aging-asia-and-pacific. Accessed 9 Aug 2021.
WHO. Hypertension fact sheet. WHO Publication. 2021. https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 9 Aug 2021.
CDC. Prevalence of select measures among adults aged 20 and over: United States, 1999–2000 through 2017–2018. NHANES Interactive Data Visualizations. 2018. https://www.cdc.gov/nchs/nhanes/visualization/. Accessed 9 Aug 2021.
Chia Y-C, Buranakitjaroen P, Chen C-H, Divinagracia R, Hoshide S, Park S, et al. Current status of home blood pressure monitoring in Asia: statement from the HOPE Asia Network. J Clin Hypertens. 2017;19(11):1192–201.
Malaysia National Health and Morbidity Survey 2015. Non-communicable diseases, risk factors and other health related problems, Vol. II. Ministry of Health Malaysia. 2015. http://www.moh.gov.my/moh/resources/nhmsreport2015vol2.pdf. Accessed 9 Aug 2021.
Pakistan Health Research Council. Non-communicable Diseases Risk Factors Survey––Pakistan. Islamabad: World Health Organization; 2016. ISBN 978-969-499-008-8.
Kario K, Wang J-G. Could 130/80 mmHg be adopted as the diagnostic threshold and management goal of hypertension in consideration of the characteristics of Asian populations? Hypertension. 2018;71(6):979–84.
Ueshima H, Sekikawa A, Miura K, Turin TC, Takashima N, Kita Y, et al. Cardiovascular disease and risk factors in Asia: a selected review. Circulation. 2008;118(25):2702–9.
Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia. 2006;49(11):2580–8.
Dou L, Liu X, Zhang T, Wu Y. Health care utilization in older people with cardiovascular disease in China. Int J Equity Health. 2015;14(1):59.
Coffman TM. The inextricable role of the kidney in hypertension. J Clin Invest. 2014;124(6):2341–7.
Coffman TM, Crowley SD. Kidney in hypertension. Hypertension. 2008;51(4):811–6.
Bidani AK, Griffin KA. Pathophysiology of hypertensive renal damage. Hypertension. 2004;44(5):595–601.
Hall JE, Granger JP, do Carmo JM, da Silva AA, Dubinion J, George E, et al. Hypertension: physiology and pathophysiology. Compr Physiol. 2012;2(4):2393–442.
Kotchen TA. Historical trends and milestones in hypertension research. Hypertension. 2011;58(4):522–38.
Sever PS, Messerli FH. Hypertension management 2011: optimal combination therapy. Eur Heart J. 2011;32(20):2499–506.
Zhao D, Liu H, Dong P, Zhao J. A meta-analysis of add-on use of spironolactone in patients with resistant hypertension. Int J Cardiol. 2017;233:113–7.
Wang C, Xiong B, Huang J. Efficacy and safety of spironolactone in patients with resistant hypertension: a meta-analysis of randomised controlled trials. Heart Lung Circ. 2016;25(10):1021–30.
Williams B, MacDonald TM, Morant SV, Webb DJ, Sever P, McInnes GT, et al. Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies. Lancet Diabet Endocrinol. 2018;6(6):464–75.
Weidmann P, De Myttenaere-Bursztein S, Maxwell MH, de Lima J. Effect on aging on plasma renin and aldosterone in normal man. Kidney Int. 1975;8(5):325–33.
Bauer JH. Age-related changes in the renin-aldosterone system. Physiological effects and clinical implications. Drugs Aging. 1993;3(3):238–45.
Messerli FH, Sundgaard-Riise K, Ventura HO, Dunn FG, Glade LB, Frohlich ED. Essential hypertension in the elderly: haemodynamics, intravascular volume, plasma renin activity, and circulating catecholamine levels. Lancet. 1983;2(8357):983–6.
Duprez DA, Munger MA, Botha J, Keefe DL, Charney AN. Aliskiren for geriatric lowering of systolic hypertension: a randomized controlled trial. J Hum Hypertens. 2010;24(9):600–8.
Mimran A, Ribstein J, Jover B. Aging and sodium homeostasis. Kidney Int Suppl. 1992;37:S107–13.
Epstein M, Hollenberg NK. Age as a determinant of renal sodium conservation in normal man. J Lab Clin Med. 1976;87(3):411–7.
Laurent S, Boutouyrie P. Arterial stiffness and hypertension in the elderly. Front Cardiovasc Med. 2020;7(202):544302.
Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003;107(22):2864–9.
Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, et al. European Resuscitation Council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation. 2010;81(10):1305–52.
Kannel WB, Dawber TR, McGee DL. Perspectives on systolic hypertension. The Framingham study. Circulation. 1980;61(6):1179–82.
Himmelmann A, Hedner T, Hansson L, O’Donnell CJ, Levy D. Isolated systolic hypertension: an important cardiovascular risk factor. Blood Press. 1998;7(4):197–207.
Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet. 1997;350(9080):757–64.
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991;265(24):3255–64.
Tanner RM, Shimbo D, Seals SR, Reynolds K, Bowling CB, Ogedegbe G, et al. White-coat effect among older adults: data from the Jackson heart study. J Clin Hypertens (Greenwich). 2016;18(2):139–45.
Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control. 2018;11:73–9.
Williams B, Mancia G, Spiering W. ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;2018:39.
Helvaci MR, Seyhanli M. What a high prevalence of white coat hypertension in society! Intern Med. 2006;45(10):671–4.
Reddy AK, Jogendra MR, Rosendorff C. Blood pressure measurement in the geriatric population. Blood Press Monit. 2014;19(2):59–63.
de Simone G, Schillaci G, Chinali M, Angeli F, Reboldi GP, Verdecchia P. Estimate of white-coat effect and arterial stiffness. J Hypertens. 2007;25(4):827–31.
Cai P, Peng Y, Wang Y, Wang X. Effect of white-coat hypertension on arterial stiffness: a meta-analysis. Medicine. 2018;97(42):e12888.
Kario K, Tomitani N, Buranakitjaroen P, Chia YC, Park S, Chen CH, et al. Home blood pressure control status in 2017-2018 for hypertension specialist centers in Asia: results of the Asia BP@Home study. J Clin Hypertens. 2018;20(12):1686–95.
Cacciolati C, Hanon O, Alpérovitch A, Dufouil C, Tzourio C. Masked hypertension in the elderly: cross-sectional analysis of a population-based sample. Am J Hypertens. 2011;24(6):674–80.
Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens. 2007;25(11):2193–8.
Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. Am J Hypertens. 2011;24(1):52–8.
Mallion J-M, Clerson P, Bobrie G, Genes N, Vaisse B, Chatellier G. Predictive factors for masked hypertension within a population of controlled hypertensives. J Hypertens. 2006;24(12):2365–70.
Gorostidi M, Vinyoles E, Banegas JR, de la Sierra A. Prevalence of white-coat and masked hypertension in national and international registries. Hypertens Res. 2015;38(1):1–7.
Obara T, Ohkubo T, Funahashi J, Kikuya M, Asayama K, Metoki H, et al. Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study. J Hypertens. 2005;23(9):1653–60.
Parashar R, Amir M, Pakhare A, Rathi P, Chaudhary L. Age related changes in autonomic functions. J Clin Diagn Res. 2016;10(3):CC11–C5.
Baker SE, Limberg JK, Dillon GA, Curry TB, Joyner MJ, Nicholson WT. Aging alters the relative contributions of the sympathetic and parasympathetic nervous system to blood pressure control in women. Hypertension. 2018;72(5):1236–42.
Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med. 2007;120(10):841–7.
Brignole M. Progressive orthostatic hypotension in the elderly. e-journal of the ESC Council for Cardiology Practice 2006;5(10). https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-5/Progressive-orthostatic-hypotension-in-the-elderly-Title-Progressive-orthosta. Accessed 9 Aug 2021.
Saedon NI, Pin Tan M, Frith J. The prevalence of orthostatic hypotension: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2020;75(1):117–22.
Grassi G, Mark A, Esler M. The sympathetic nervous system alterations in human hypertension. Circ Res. 2015;116(6):976–90.
Esler M. The sympathetic nervous system in hypertension: back to the future? Curr Hypertens Rep. 2015;17(2):11.
Catheter-based renal sympathetic denervation for resistant hypertension: Durability of blood pressure reduction out to 24 months. Hypertension 2011;57(5):911–7.
Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376(9756):1903–9.
Courand PY, Feugier P, Workineh S, Harbaoui B, Bricca G, Lantelme P. Baroreceptor stimulation for resistant hypertension: first implantation in France and literature review. Arch Cardiovasc Dis. 2014;107(12):690–6.
Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370(15):1393–401.
Cuspidi C, Sala C, Negri F, Mancia G, Morganti A. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26(6):343–9.
Ching S, Chia Y, Azman WW. Prevalence and determinants of left ventricular hypertrophy in hypertensive patients at a primary care clinic. Malays Fam Physician. 2012;7(2–3):2.
Krumholz HM, Larson M, Levy D. Sex differences in cardiac adaptation to isolated systolic hypertension. Am J Cardiol. 1993;72(3):310–3.
Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. New insights into the relationship of left ventricular geometry and left ventricular mass with cardiac function: a population study of hypertensive subjects. Eur Heart J. 2010;31(5):588–94.
Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19(7):1550–8.
Devereux RB, James GD, Pickering TG. What is normal blood pressure? Comparison of ambulatory pressure level and variability in patients with normal or abnormal left ventricular geometry. Am J Hypertens. 1993;6(6 Pt 2):211s–5s.
Sweitzer NK, Lopatin M, Yancy CW, Mills RM, Stevenson LW. Comparison of clinical features and outcomes of patients hospitalized with heart failure and normal ejection fraction (> or =55%) versus those with mildly reduced (40% to 55%) and moderately to severely reduced (<40%) fractions. Am J Cardiol. 2008;101(8):1151–6.
Goldberg RJ, Spencer FA, Farmer C, Meyer TE, Pezzella S. Incidence and hospital death rates associated with heart failure: a community-wide perspective. Am J Med. 2005;118(7):728–34.
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics 2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–596.
Butrous H, Hummel SL. Heart failure in older adults. Can J Cardiol. 2016;32(9):1140–7.
Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27(22):2725–36.
Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296(18):2217–26.
Oh GC, Cho H-J. Blood pressure and heart failure. Clin Hypertens. 2020;26(1):1.
Choi DJ, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, et al. Characteristics, outcomes and predictors of long-term mortality for patients hospitalized for acute heart failure: a report from the Korean Heart Failure Registry. Korean Circ J. 2011;41(7):363–71.
Lee SE, Lee HY, Cho HJ, Choe WS, Kim H, Choi JO, et al. Clinical characteristics and outcome of acute heart failure in Korea: results from the Korean Acute Heart Failure Registry (KorAHF). Korean Circ J. 2017;47(3):341–53.
Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269–76.
Murad K, Goff DC Jr, Morgan TM, Burke GL, Bartz TM, Kizer JR, et al. Burden of comorbidities and functional and cognitive impairments in elderly patients at the initial diagnosis of heart failure and their impact on total mortality: the cardiovascular health study. JACC Heart Fail. 2015;3(7):542–50.
Marengoni A, Tazzeo C, Calderón-Larrañaga A, Roso-Llorach A, Onder G, Zucchelli A, et al. Multimorbidity patterns and 6-year risk of institutionalization in older persons: the role of social formal and informal care. J Am Med Dir Assoc. 2021;22:2184.
Karamichalakis N, Letsas KP, Vlachos K, Georgopoulos S, Bakalakos A, Efremidis M, et al. Managing atrial fibrillation in the very elderly patient: challenges and solutions. Vasc Health Risk Manag. 2015;11:555–62.
Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5.
Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34(35):2746–51.
Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation. Circulation. 2014;129(8):837–47.
Kistler PM, Sanders P, Fynn SP, Stevenson IH, Spence SJ, Vohra JK, et al. Electrophysiologic and electroanatomic changes in the human atrium associated with age. J Am Coll Cardiol. 2004;44(1):109–16.
Nabauer M, Gerth A, Limbourg T, Schneider S, Oeff M, Kirchhof P, et al. The Registry of the German competence NETwork on atrial fibrillation: patient characteristics and initial management. Europace. 2009;11(4):423–34.
Verdecchia P, Angeli F, Reboldi G. Hypertension and atrial fibrillation. Circ Res. 2018;122(2):352–68.
Dominiczak A, Delles C, Padmanabhan S. Genomics and precision medicine for clinicians and scientists in hypertension. Hypertension. 2017;69(4):e10–e3.
Kato N, Loh M, Takeuchi F, Verweij N, Wang X, Zhang W, et al. Trans-ancestry genome-wide association study identifies 12 genetic loci influencing blood pressure and implicates a role for DNA methylation. Nat Genet. 2015;47(11):1282–93.
Mattson DL, Liang M. Hypertension: from GWAS to functional genomics-based precision medicine. Nat Rev Nephrol. 2017;13(4):195–6.
Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288–98.
Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin N Am. 2004;33(2):351–75.
Ramachandran A, Chamukuttan S, Shetty SA, Arun N, Susairaj P. Obesity in Asia – is it different from rest of the world. Diabetes Metab Res Rev. 2012;28(s2):47–51.
McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991;337(8738):382–6.
Larsson SC, Bäck M, Rees JMB, Mason AM, Burgess S. Body mass index and body composition in relation to 14 cardiovascular conditions in UK Biobank: a Mendelian randomization study. Eur Heart J. 2020;41(2):221–6.
Zamboni M, Mazzali G. Obesity in the elderly: an emerging health issue. Int J Obes. 2012;36(9):1151–2.
Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491–7.
Ariaratnam S, Rodzlan Hasani WS, Krishnapillai AD, Abd Hamid HA, Jane Ling MY, Ho BK, et al. Prevalence of obesity and its associated risk factors among the elderly in Malaysia: findings from The National Health and Morbidity Survey (NHMS) 2015. PLoS One. 2020;15(9):e0238566.
Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014;371(7):624–34.
WHO. Fact sheet on salt reduction. WHO Publication. 2020. https://www.who.int/news-room/fact-sheets/detail/salt-reduction. Accessed 9 Aug 2021.
INTERSALT study an international co-operative study on the relation of blood pressure to electrolyte excretion in populations. I. Design and methods. The INTERSALT Co-operative Research Group. J Hypertens. 1986;4(6):781–7.
Dahl. Possible role of salt intake in the development of essential hypertension. In: Cottier P, Bock D, editors. Essential hypertension: an international symposium. Berlin: Springer; 1960. p. 52–65.
Stamler J. The INTERSALT Study: background, methods, findings, and implications. Am J Clin Nutr. 1997;65(2 Suppl):626s–42s.
Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ. 1988;297(6644):319–28.
Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med. 2001;344(1):3–10.
Zhou BF, Stamler J, Dennis B, Moag-Stahlberg A, Okuda N, Robertson C, et al. Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTERMAP study. J Hum Hypertens. 2003;17(9):623–30.
Katsuya T, Ishikawa K, Sugimoto K, Rakugi H, Ogihara T. Salt sensitivity of Japanese from the viewpoint of gene polymorphism. Hypertens Res. 2003;26(7):521–5.
Obarzanek E, Proschan MA, Vollmer WM, Moore TJ, Sacks FM, Appel LJ, et al. Individual blood pressure responses to changes in salt intake. Hypertension. 2003;42(4):459–67.
Stamler J, Rose G, Stamler R, Elliott P, Dyer A, Marmot M. INTERSALT study findings. Public health and medical care implications. Hypertension. 1989;14(5):570–7.
Higashi Y, Oshima T, Ozono R, Nakano Y, Matsuura H, Kambe M, et al. Nocturnal decline in blood pressure is attenuated by NaCl loading in salt-sensitive patients with essential hypertension: noninvasive 24-hour ambulatory blood pressure monitoring. Hypertension. 1997;30(2 Pt 1):163–7.
Takakuwa H, Shimizu K, Izumiya Y, Kato T, Nakaya I, Yokoyama H, et al. Dietary sodium restriction restores nocturnal reduction of blood pressure in patients with primary aldosteronism. Hypertens Res. 2002;25(5):737–42.
Yatabe MS, Yatabe J, Yoneda M, Watanabe T, Otsuki M, Felder RA, et al. Salt sensitivity is associated with insulin resistance, sympathetic overactivity, and decreased suppression of circulating renin activity in lean patients with essential hypertension. Am J Clin Nutr. 2010;92(1):77–82.
Melander O, Groop L, Hulthén UL. Effect of salt on insulin sensitivity differs according to gender and degree of salt sensitivity. Hypertension. 2000;35(3):827–31.
Ebata H, Hojo Y, Ikeda U, Ishida H, Natsume T, Shimada K. Differential effects of an alpha 1-blocker (doxazosin) on diurnal blood pressure variation in dipper and non-dipper type hypertension. Hypertens Res. 1995;18(2):125–30.
O’Sullivan C, Duggan J, Atkins N, O’Brien E. Twenty-four-hour ambulatory blood pressure in community-dwelling elderly men and women, aged 60-102 years. J Hypertens. 2003;21(9):1641–7.
Imai Y, Nagai K, Sakuma M, Sakuma H, Nakatsuka H, Satoh H, et al. Ambulatory blood pressure of adults in Ohasama, Japan. Hypertension. 1993;22(6):900–12.
Uzu T, Ishikawa K, Fujii T, Nakamura S, Inenaga T, Kimura G. Sodium restriction shifts circadian rhythm of blood pressure from nondipper to dipper in essential hypertension. Circulation. 1997;96(6):1859–62.
Uzu T, Kimura G, Yamauchi A, Kanasaki M, Isshiki K, Araki SI. Enhanced sodium sensitivity and disturbed circadian rhythm of blood pressure in essential hypertension. J Hypertens. 2006;24:1627.
He J, Gu D, Chen J, Jaquish CE, Rao DC, Hixson JE, et al. Gender difference in blood pressure responses to dietary sodium intervention in the GenSalt study. J Hypertens. 2009;27(1):48–54.
Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG, et al. Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med. 2001;135(12):1019–28.
Weinberger MH, Fineberg NS. Sodium and volume sensitivity of blood pressure. Age and pressure change over time. Hypertension. 1991;18(1):67–71.
Elijovich F, Weinberger MH, Anderson CA, Appel LJ, Bursztyn M, Cook NR, et al. Salt sensitivity of blood pressure: a scientific statement from the American Heart Association. Hypertension. 2016;68(3):e7–e46.
Liu Y, Shi M, Dolan J, He J. Sodium sensitivity of blood pressure in Chinese populations. J Hum Hypertens. 2020;34(2):94–107.
Mitsutake SIT, Teramoto C, Shimizu S, Ito H. Patterns of co-occurrence of chronic disease among older adults in Tokyo, Japan. Prev Chronic Dis. 2019;16(180170) https://doi.org/10.5888/pcd16.180170. Accessed 9 Aug 2021.
Jang I-Y, Lee HY, Lee E. Th anniversary Committee of Korean Geriatrics S. geriatrics fact sheet in Korea 2018 from National Statistics. Ann Geriatr Med Res. 2019;23(2):50–3.
Kim H-A, Shin J-Y, Kim M-H, Park B-J. Prevalence and predictors of polypharmacy among Korean elderly. PLoS One. 2014;9(6):e98043.
Mabuchi T, Hosomi K, Yokoyama S, Takada M. Polypharmacy in elderly patients in Japan: analysis of Japanese real-world databases. J Clin Pharm Ther. 2020;45(5):991–6.
Morin L, Johnell K, Laroche M-L, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018;10:289–98.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104.
Chia Y-C, Turana Y, Sukonthasarn A, Zhang Y, Shin J, Cheng H-M, et al. Comparison of guidelines for the management of hypertension: similarities and differences between international and Asian countries; perspectives from HOPE-Asia Network. J Clin Hypertens. 2021;23(3):422–34.
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334–57.
Whelton PK, Williams B. The 2018 European Society of Cardiology/European Society of Hypertension and 2017 American College of Cardiology/American Heart Association blood pressure guidelines: more similar than DifferentComparison of the 2018 ESC/ESH and 2017 ACC/AHA hypertension GuidelinesComparison of the 2018 ESC/ESH and 2017 ACC/AHA hypertension guidelines. JAMA. 2018;320(17):1749–50.
Chia Y. Review of tools of cardiovascular disease risk stratification: interpretation, customisation and application in clinical practice. Singap Med J. 2011;52(2):116–23.
Bulpitt C, Fletcher A, Beckett N, Coope J, Gil-Extremera B, Forette F, et al. Hypertension in the very elderly trial (HYVET): protocol for the main trial. Drugs Aging. 2001;18(3):151–64.
Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887–98.
Liu J. Highlights of the 2018 Chinese hypertension guidelines. Clin Hypertens. 2020;26(1):8.
Kim HC, Ihm S-H, Kim G-H, Kim JH, Kim K-i, Lee H-Y, et al. 2018 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology of hypertension. Clin Hyperten. 2019;25(1):16.
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42(9):1235–481.
Philippines clinical practice guideline for adult hypertension-prevention, screening, counseling and management. 2018. www.mahealthcare.com/pdf/practice_guidelines.
2018 Vietnam National Heart Association/Vietnam Society of Hypertension guidelines on diagnosis and treatment of arterial hypertension in adults. 2018 VNHA/VSH guidelines for diagnosis and treatment of hypertension … slideshare.net. Accessed 9 Aug 2021.
2018 Pakistan Hypertension League 3rd National Guideline for the prevention, detection, evaluation and Managment of hypertension 2018. PHL 2018 Magazine Final 1. phlpk.org. Accessed 9 Aug 2021.
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Chia, YC. (2022). Hypertension in the Elderly: Pathophysiology and Clinical Significance. In: Ram, C.V.S., Teo, B.W.J., Wander, G.S. (eds) Hypertension and Cardiovascular Disease in Asia. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-030-95734-6_17
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DOI: https://doi.org/10.1007/978-3-030-95734-6_17
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Publisher Name: Springer, Cham
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Online ISBN: 978-3-030-95734-6
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