Essential Hypertension in the Elderly

  • Franz H. Messerli
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 76)


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.


Essential Hypertension Left Ventricular Hypertrophy Plasma Renin Activity Renal Blood Flow Systolic Hypertension 
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  1. 1.
    Messerli FH. Hypertension Update II Symposium. Washington D.C.: Health Learning Systems, 1985.Google Scholar
  2. 2.
    Gavras H and Gavras I (eds). Hypertension in the Elderly. Boston: John Wright Publishers, 1983.Google Scholar
  3. 3.
    Kaplan NN. Hypertension in patients over 65. Consultant, May 1980, pp 210–217.Google Scholar
  4. 4.
    Kirkendall WM and Hammond JJ. Hypertension in the elderly. Arch Intern Med 140:1155–1161, 1980.PubMedCrossRefGoogle Scholar
  5. 5.
    Messerli FH. Hypertension in the elderly. In FH Messerli (ed), Cardiovascular Disease in the Elderly. Boston: Martinus Nijhoff Publishing, 1984, pp 65–81.CrossRefGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. 7.
    Ostfeld AM. Early hypertensive patient: Epidemiological review. NY State J Med 78:1125–1129, 1978.Google Scholar
  8. 8.
    Messerli FH. Essential hypertension in the elderly: Haemodynamics, intravascular volume, plasma renin activity, and circulating catecholamine levels. Lancet 2:983–986, 1983.PubMedCrossRefGoogle Scholar
  9. 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. 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. 11.
    Friesf F. Aging, natural death, and the compression of morbidity. N Engl J Med 303:130–135, 1980.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 13.
    Kannel WB and Gordon T. Evaluation of cardiovascular risk in the elderly: The Framingham study. Bull NY Acad Med 54:573–591, 1978.Google Scholar
  14. 14.
    Shekelle RB, Ostfeld AM, -and Klawans HF Jr. Hypertension and risk of stroke in an elderly population. Stroke 5:71–75, 1974.PubMedCrossRefGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 19.
    Australian therapeutic trial in mild hypertension. Report by the Management Committee. Lancet 1:1261–1267, 1980.Google Scholar
  20. 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.CrossRefGoogle Scholar
  21. 21.
    Hypertension-Stroke Cooperative Study Group. Effect of antihypertensive treatment on stroke recurrence. JAMA 229:409–418, 1974.CrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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. 25.
    Lund-Johansen P. Hemodynamic response: Decrease in cardiac output vs reduction in vascular resistance. Hypertension 5:III 49–57, 1983.Google Scholar
  26. 26.
    Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 248:1465–1477, 1982.CrossRefGoogle Scholar
  27. 27.
    Weidmann P, Gerber A, and Mordäsini R. Effects of antihypertensive therapy on serum lipoproteins. Hypertension 5:III 120–131, 1983.Google Scholar
  28. 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. 29.
    Messerli FH. Management of hypertension in the elderly. Curr Med Res Opin 8(suppl 1):30–38, 1982.CrossRefGoogle Scholar
  30. 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. 31.
    Messerli FH. Essential hypertension in the elderly. Triangle 24:35–47, 1985.Google Scholar
  32. 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. 33.
    Brandfonbrener M, Landowne M, and Shock NW. Changes in cardiac output with age. Circulation 12:557–566, 1955.PubMedCrossRefGoogle Scholar
  34. 34.
    Conway J, Wheeler R, and Sannerstedt R. Sympathetic nervous activity during exercise in relation to age. Cardiovasc Res 5:577–581, 1971.PubMedCrossRefGoogle Scholar
  35. 35.
    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
  36. 36.
    Messerli FH, Frohlich ED, Suarez DH, et al. Borderline hypertension: Relationship between age, hemodynamics, and circulating catecholamines. Circulation 64:760–764, 1981.PubMedCrossRefGoogle Scholar
  37. 37.
    Standell T. Circulatory studies on healthy old men. Acta Med Scand 175(suppl 414):1–44, 1964.Google Scholar
  38. 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.CrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 40.
    Messerli FH. Individualization of antihypertensive therapy: An approach based on hemodynamics and age. J Clin Pharmacol 21:517–528, 1981.PubMedCrossRefGoogle Scholar
  41. 41.
    Fries ED. Hemodynamics of hypertension. Physiol Rev 40:27–54, 1960.Google Scholar
  42. 42.
    Messerli FH. Clinical determinants and consequences of left ventricular hypertrophy. Am J Med 75:51–63, 1983.PubMedCrossRefGoogle Scholar
  43. 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. 44.
    Gerstenblith G, Weisfeldt ML, and Lakatta EG. Age changes in myocardial function and exercise response. Prog Cardiovasc Dis 19:1–21, 1976.PubMedCrossRefGoogle Scholar
  45. 45.
    Sjogren AL. Left ventricular wall thickness determined by ultrasound in 100 subjects without heart disease. Chest 60:341–346, 1971.PubMedCrossRefGoogle Scholar
  46. 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.PubMedCrossRefGoogle Scholar
  47. 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. 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.PubMedCrossRefGoogle Scholar
  49. 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. 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.PubMedCrossRefGoogle Scholar
  51. 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.PubMedCrossRefGoogle Scholar
  52. 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.PubMedCrossRefGoogle Scholar
  53. 53.
    Hollenberg NK and Adams DF. The renal circulation in hypertensive disease. Am J Med 60:773–784, 1976.PubMedCrossRefGoogle Scholar
  54. 54.
    Reubi FC, Weidmann P, Hodler J, and Cottier PT. Changes in renal function in essential hypertension. Am J Med 64:556–563, 1978.PubMedCrossRefGoogle Scholar
  55. 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.PubMedCrossRefGoogle Scholar
  56. 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.Google Scholar
  57. 57.
    Crane MG, Harris JJ, and Johns VJ. Hyporeninemic hypertension. Am J Med 52:457–466, 1972.PubMedCrossRefGoogle Scholar
  58. 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.PubMedCrossRefGoogle Scholar
  59. 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.PubMedCrossRefGoogle Scholar
  60. 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.PubMedCrossRefGoogle Scholar
  61. 61.
    Meade TW, Imeson JD, Gordon D, and Peart WS. The epidemiology of plasma renin. Clin Sci 64:273–280, 1983.PubMedGoogle Scholar
  62. 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.PubMedCrossRefGoogle Scholar
  63. 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.PubMedCrossRefGoogle Scholar
  64. 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.PubMedCrossRefGoogle Scholar
  65. 65.
    Goldstein DS. Plasma catecholamines and essential hypertension: An analytical review. Hypertension 5:86–99, 1983.PubMedCrossRefGoogle Scholar
  66. 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.PubMedCrossRefGoogle Scholar
  67. 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.PubMedCrossRefGoogle Scholar
  68. 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.PubMedCrossRefGoogle Scholar
  69. 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.PubMedGoogle Scholar
  70. 70.
    Vestal RE, Wood JJ, and Shand DG. Reduced beta-adrenoceptor sensitivity in the elderly. Clin Pharmacol 26:181–186, 1979.Google Scholar
  71. 71.
    Kelly J and O’Malley K. Adrenoreceptor function and aging. Clin Science 66:509–515, 1984.Google Scholar
  72. 72.
    Colandrea MA, Friedman GD, Nichaman MZ, et al. Systolic hypertension in the elderly. Circulation 41:239–245, 1970.PubMedCrossRefGoogle Scholar
  73. 73.
    Messerli FH, Ventura HO, Aristimuno GG, et al. Arterial compliance in systolic hypertension. Clin Exp Hypertens A4:1037–1044, 1982.CrossRefGoogle Scholar
  74. 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. 75.
    Vardan S, Mookherjee S, Warner R, and Smulyan H. Systolic hypertension: Direct and indirect BP measurements. Arch Intern Med 143:935–938, 1983.PubMedCrossRefGoogle Scholar
  76. 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.CrossRefGoogle Scholar
  77. 77.
    Osler W. Principles and Practice of Medicine. New York: Appleton, Century, & Croft, 1982.Google Scholar
  78. 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. 79.
    Messerli FH, Ventura HO, and Amodeo C. Osler’s maneuver and pseudohypertension. N Engl J Med 312:1548–1551, 1985.PubMedCrossRefGoogle Scholar
  80. 80.
    Messerli FH. Cardiovascular effects of obesity and hypertension. Lancet 1:1165–1168, 1982.PubMedCrossRefGoogle Scholar
  81. 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.PubMedCrossRefGoogle Scholar
  82. 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.PubMedCrossRefGoogle Scholar
  83. 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.PubMedCrossRefGoogle Scholar
  84. 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. 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.PubMedCrossRefGoogle Scholar
  86. 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. 87.
    Henry PD. Atherosclerosis, calcium and calcium antagonists. Circulation 72:456–459, 1985.PubMedCrossRefGoogle Scholar
  88. 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.PubMedCrossRefGoogle Scholar
  89. 89.
    Tarazi RC, Bravo EL, Fouad FM, et al. Hemodynamic and volume changes associated with captopril. Hypertension 2:576–585, 1980.PubMedCrossRefGoogle Scholar
  90. 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. 91.
    Lund-Johansen P. The effects of beta blocker therapy on chronic hemodynamics. Primary Cardiology 1:20–28, 1980.Google Scholar
  92. 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. 93.
    Grabner W and Weidinger G. Hypertonie und Dehydroergotosin? Med Klin 77, 1982.Google Scholar
  94. 94.
    Welzel D, Weidinger G, and Koppenhagen K. Zentrale Hamodynamik der Antihypertensiva. Untersuchungen mit Co-Dergocrinmesylat. Dtsch Med Wochenschr 109:1064–1068, 1984.PubMedCrossRefGoogle Scholar

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  • Franz H. Messerli

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