Metabolic and Cardiovascular Manifestations of Hypertension in the Elderly

  • V. Rajkumar
  • Luis C. Afonso
  • Joel Steinberg
  • Stephen L. Farrow
  • James R. Sowers

Abstract

Aging in industrialized societies is associated with an increasing prevalence of hypertension, type II diabetes mellitus, renal disease and atherosclerotic vascular disease. This increase in chronic disease processes in industrialized societies is related, in part, to increasing obesity, reduced physical activity, medications such as non-steroidal anti-inflammatory agents, and other environmental influences. Hypertension in the elderly is characterized by high peripheral vascular resistance, reduced baroreflex sensitivity, a low renin state with reduced cardiac output / increased hypertrophy, reduced intravascular volume, and an increased propensity to salt-sensitivity. Type II diabetes commonly accompanies hypertension in the elderly, in part related to reduction in lean body mass and relative increase in adiposity. Lipid abnormalities are also relatively common in the elderly and should generally be treated in a similar fashion to those in the middle-aged individual.

Keywords

Estrogen Replacement Therapy Atherosclerotic Vascular Disease Isolate Systolic Hypertension Multiple Risk Factor Intervention Trial National High Blood Pressure 
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.

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References

  1. 1.
    Sowers JR, Farrow SL. Treatment of elderly hypertensive patients with diabetes, renal disease, and coronary heart disease. Am J Geriatr Cardiol 1996;5:57–70.PubMedGoogle Scholar
  2. 2.
    Bush TL. The epidemiology of cardiovascular disease in postmenopausal women. Ann NY Acad Sci 1990;592:262–271.CrossRefGoogle Scholar
  3. 3.
    Stuck SE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a metaanalysis of controlled trials. Lancet 1993;342:1032–1036.PubMedCrossRefGoogle Scholar
  4. 4.
    Robinson JG, Leon AS. The prevention of cardiovascular disease: emphasis on secondary prevention. Med Clin North Am 1994;78:69.PubMedGoogle Scholar
  5. 5.
    Scott M, Owen P, Porter P, et al. Prevalence of adults with no known risk factors for coronary heart disease. Behavioral risk factor surveillance system, 1992. MMWR 1994;43:61Google Scholar
  6. 6.
    Stamler J, Wentworth D, Neaton JD. Is the relationship between serum cholesterol and risk of premature death from coronary Heart disease continuous and graded? Findings in 356, 222 primary screenees of the Multiple Risk Factor Intervention Trial MRFIT JAMA 1986;256:2823–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Lau J, Antman EM, Jimenez-Silva J, et al. Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med 1992;327:248.PubMedCrossRefGoogle Scholar
  8. 8.
    Adult Treatment Panel II: Second report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Circulation 1994;89:1336.Google Scholar
  9. 9.
    Malenka DJ, Baron JA. Cholesterol and coronary heart disease: the importance of patient-specific attributable risk. Arch Intern Med 1988;148:2247–2252.PubMedCrossRefGoogle Scholar
  10. 10.
    Vokonas PS, Kannel WB, Cupples LA: Epidemiology and risk of hypertension in the elderly: The Framingham study. J Hypertens 1988;6 suppl I:S3–S9.Google Scholar
  11. 11.
    Whelton PK, Klag MJ: Epidemiology of high blood pressure. Clin Geriatr Med 1989;5:639–655.PubMedGoogle Scholar
  12. 12.
    Sowers JR, Khoury S, Imam K, et al: Therapeutic approach to hypertension in the elderly. Primary Care 1991;18:593–604.PubMedGoogle Scholar
  13. 13.
    The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure JNC-V. Arch Intern Med 1993; 153:154-183.Google Scholar
  14. 14.
    Perry HM, Smith WM, McDonald RH, et al. Morbidity and mortality in the Systolic Hypertension in the Elderly Program SHEP pilot study. Stroke 1989;20:4–13.PubMedCrossRefGoogle Scholar
  15. 15.
    Kuramato K, Matsushito S, Kuwajimi I. The pathogenetic role of elderly hypertension. Jpn Circ J 1981;45:833–843.CrossRefGoogle Scholar
  16. 16.
    Sowers JR. Hypertension in the elderly. Am J Med 1987;82:1–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Sowers JR, Mohanty PK. Effects of advancing age on cardiopulmonary baroreceptor function in hypertensive men. Hypertension 1987;10:274–279.PubMedCrossRefGoogle Scholar
  18. 18.
    Sowers JR, Mohanty PK. Norepinephrine and forearm vascular resistance responses to tilt and cold pressor test in essential hypertension: Effects of aging. Angiology 1989;40 10:872–879.PubMedCrossRefGoogle Scholar
  19. 19.
    Fleich JH, Hooker CS. The relationship between age and relaxation of vascular smooth muscle in the rabbit and rat. Circ Res 1976;38:243–249.CrossRefGoogle Scholar
  20. 20.
    Shimada K, Kitazumi T, Sadakane N, Ogura H, Ozawa T. Age-related changes of baroreflex function, plasma norepinephrine, and blood pressure. Hypertension 1985;7:113–117.PubMedCrossRefGoogle Scholar
  21. 21.
    Khoury S, Yarows S, O’Brian T, Sowers JR. Ambulatory blood pressure monitoring in a nonacademic setting: Effects of age and sex. Am J Hypertens 1992;5:616–623.PubMedCrossRefGoogle Scholar
  22. 22.
    Sowers JR, Rubenstein LZ, Stern N. Plasma norepinephrine responses to posture and isometric exercise with age in the absence of obesity. J Gerontol 1983;38:315–317.PubMedCrossRefGoogle Scholar
  23. 23.
    Gambert SR, Duthie EH. Effect of age on red cell membrane sodium-potassium dependent adenosine triphosphatase activity in healthy men. J Gerontol 1983;38:23–28.PubMedCrossRefGoogle Scholar
  24. 24.
    Van Brummelen P, Buhler FR, Kiowski W, et al. Age-related increase in cardiac and peripheral vascular responses to isoproterenol: studies in normal subjects. Clin Sci 1981;60:571–577.PubMedGoogle Scholar
  25. 25.
    Lindeman RD, Tobin JD, Shock NW. Association between blood pressure and the rate of decline in renal function with age. Kidney Int 1984;26:861–868.PubMedCrossRefGoogle Scholar
  26. 26.
    Brown WW, Davis BB, Spry LA, et al. Aging and the kidney. Arch Intern Med 1986; 146:1790–96.PubMedCrossRefGoogle Scholar
  27. 27.
    Anderson S, Brenner BM. Effects of aging on the renal glomerulus. Am J Med 1986;80:435–442.PubMedCrossRefGoogle Scholar
  28. 28.
    Weinberger MH, Fineberg NS. Sodium and volume sensitivity of blood pressure: Age and pressure change over time. Hypertension 1991; 18:67–72.PubMedCrossRefGoogle Scholar
  29. 29.
    Zemel MB, Sowers JR. Salt-sensitivity and hypertension in the elderly. Am J Cardiol 1988;61:7H–12H.PubMedCrossRefGoogle Scholar
  30. 30.
    Sowers JR, Zemel MB, Zemel P, Beck FWJ. Walsh MF, Zawada ET. Salt sensitivity in blacks: salt intake and natriuretic substances. Hypertension 1988;12:485–90.PubMedCrossRefGoogle Scholar
  31. 31.
    Borkan GA, Norris AH. Fat redistribution and the changing body dimensions of the adult male. Hum Biol 1977;49:495–514.PubMedGoogle Scholar
  32. 32.
    Flynn MA, Nolph GB, Baker AS, Martin WM, Krause G. Total body potassium in aging humans: a longitudinal study. Am J Clin Nutr 1989;50:713–717.PubMedGoogle Scholar
  33. 33.
    Durning J, Womerskly J. Body fat assessed from total body density and its estimation from skin fold thickness: Measurements in 481 men and women aged from 16 to 72 years. Br J Nutr 1974;32:77–97.CrossRefGoogle Scholar
  34. 34.
    Sowers JR, Standley PR, Ram JL, et al. Insulin resistance, carbohydrate metabolism, and hypertension. Am J Hypertens 1991;4:466S–472S.PubMedGoogle Scholar
  35. 35.
    Fukagawa NK, Bandini LG, Young JB. Effect of age on body composition and resting metabolic rate. Am J Physiol 1990;259:E233–E238.PubMedGoogle Scholar
  36. 36.
    Flack JM, Sowers Jr. Epidemiologic and clinical aspects of insulin resistance and hyperinsulinemia. Am J Med 1991;91 suppl 1A;11S–21S.PubMedCrossRefGoogle Scholar
  37. 37.
    Poelman ET, Toth MJ, Bunyard LB, Gardner AW, Donalson KE, Colman E, Fonong T, Ades PA. Physiological predictions of increasing total and central adiposity in aging men and women. Arch Int Med 1995;155:2443–48.CrossRefGoogle Scholar
  38. 38.
    Kohrt WM, Obert KA, Holloszy JO. Exercise training improves fat distribution patterns in 60-to 70-year-old men and women. J Gerontol 1992;47:M99–M105.PubMedCrossRefGoogle Scholar
  39. 39.
    Troisi RJ, Heinold JW, Vokonas PS, Weiss ST. Cigarette smoking, dietary intake, and physical activity: effects on body fat distribution: the Normative Aging Study. Am J Clin Nutr 1991;53:1104–1111.PubMedGoogle Scholar
  40. 40.
    Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga P. Waist to hip ratio in middle-aged women: associations with behavioral and psychological factors and with changes in cardiovascular risk factors. Arterioscler Thromb 1991; 11:1250–1257.PubMedCrossRefGoogle Scholar
  41. 41.
    Schwartz RS, Shuman WP, Larson V, et al. The effect of intensive endurance exercise training on body fat distribution in young and older men. Metabolism 1991;40:545–551.PubMedCrossRefGoogle Scholar
  42. 42.
    Folsom AR, Kaye SA, Sellers TA, et al. Body fat distribution and 5-year risk of death in older women. JAMA 1993;269:483–487.PubMedCrossRefGoogle Scholar
  43. 43.
    Harris MI, Hades WC, Knowler WC, Bennet PH. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in US population aged 2-74 years. Diabetes 1987;36:423–434.CrossRefGoogle Scholar
  44. 44.
    Saad MF, Pettit DJ, Mott DM, Knowler WC, Nelson RG, Bennett PH. Sequential changes in serum insulin concentration during development of non-insulin-dependent diabetes. Lancet 1989;1:1356–1359.PubMedCrossRefGoogle Scholar
  45. 45.
    Reaven EP, Curry DL, Reaven GM. Effect of age and sex on rat endocrine pancreas. Diabetes 1987;36:1397–4000.PubMedCrossRefGoogle Scholar
  46. 46.
    Maclean N, Ogilvie RF. Quantitative estimation of the pancreatic islet tissue in diabetic subjects. Diabetes 1955;4:367–376.PubMedGoogle Scholar
  47. 47.
    Reaven GM, Reaven E. Age, glucose intolerance, and non-insulin-dependent diabetes mellitus. J Am Geriatr Soc 1985;33:286–290.PubMedGoogle Scholar
  48. 48.
    Rowe JW, Minnaker KL, Pallotta JA, Flier JS. Characterization of the insulin resistance of aging. J Clin Invest 1983;71:1581–1587.PubMedCrossRefGoogle Scholar
  49. 49.
    Fink RI, Wallace P, Olefsky JM. Effects of aging on glucose-mediated glucose disposal and glucose transport J Clin Invest 1986;77:2034-2041PubMedCrossRefGoogle Scholar
  50. 50.
    Reaven GM, Chen N, Hollenbeck C, Chen Y-DI. Effects of age on glucose tolerance and glucose uptake in healthy individuals. J Am Geriatr Soc 1989;37:735–740.PubMedGoogle Scholar
  51. 51.
    Wilson PWF, Anderson KM, Kannel WB. Epidemiology of diabetes mellitus in the elderly. Am J Med 1986;80(suppl 5A):3–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Goldberg AP, Coon PJ. Non-insulin-dependent diabetes mellitus in the elderly. Influence of obesity and physical inactivity. Endocrinol Metab Clin North Am 1987; 16(4):843–865.PubMedGoogle Scholar
  53. 53.
    Aronow WS, Herzig AH, Etienne F, D’Alba P, Ronquillo J. 41 Month follow-up risk factors correlated with new coronary events in 708 elderly patients. J Am Geriatr Soc 1989;37:501–506.PubMedGoogle Scholar
  54. 54.
    Barrett-Connor EL, Cohn BA, Wingard DL, Edelstein SL. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study. JAMA 1991;265:627–631.PubMedCrossRefGoogle Scholar
  55. 55.
    The National High Blood Pressure Education Program Working Group. National High Blood Pressure Education program Working Group report on hypertension in diabetes. Hypertension 1994;23:145–158.CrossRefGoogle Scholar
  56. 56.
    Sowers JR, Epstein M. Diabetes mellitus and hypertension: an update. Hypertension 1995;26(part l):869–879.PubMedCrossRefGoogle Scholar
  57. 57.
    Bass KM, Newschaffer CJ, Klag MJ, Bush TL. Plasma lipoprotein levels as predictors of cardiovascular death in women. Arch Intern Med 1993;153:2209–15.PubMedCrossRefGoogle Scholar
  58. 58.
    Manolio TA, Pearson TA, Wenger NK, Barrett-Connor E, Payne GH, Harlan WR. Cholesterol and heart disease in older persons and women. Review of an NHLBI workshop. Ann Epidemiol 1992;2:161–176.CrossRefGoogle Scholar
  59. 59.
    Benfante R. Is elevated cholesterol level a risk factor for coronary artery disease in the elderly? JAMA 1990; 263: 393.PubMedCrossRefGoogle Scholar
  60. 60.
    Mukerji V, Holman AJ, Artis AK, et al. Risk factors for coronary atherosclerosis in the elderly. Angiology 1989; 40:88.PubMedCrossRefGoogle Scholar
  61. 61.
    Castelli WP, Wilson PW, Levy D, Anderson K. Cardiovascular risk factors in the elderly. Am J Cardiology 1989; 63: 12H–19H.CrossRefGoogle Scholar
  62. 62.
    Aronow WP, Starling I, Etienne F et al. Risk factors for coronary artery disease in persons older than 62 in a long term care facility. Am J Cardiology 1986; 57: 518–520.CrossRefGoogle Scholar
  63. 63.
    Terranova R, Luca S. Effects of treatment with Simvastatin in elderly patients with primary hyper-cholesterolemia. Rivista Europea Per Le Scienze Mediche e Farmacologiche 1993; 15(3–4): 163–170.PubMedGoogle Scholar
  64. 64.
    Law MR, Wald NJ, Thopson SG. By how much and how quickly does reduction in serum cholesterol concentrations lowerrisk of ischewmic heart disease? Br Med J 1994; 308:367–372.CrossRefGoogle Scholar
  65. 65.
    Davenport J, Whittaker K. Secondary prevention in elderly survivors of heart attacks. AFP 1988;38(1):216–224.Google Scholar
  66. 66.
    La Rosa JC. Dyslipoproteinemia in women and the elderly. Med Clin North Am. 1994;78:163.Google Scholar
  67. 67.
    Expert Panel on Detection, Evaluation and Treatment of High Blood cholesterol in Adults: Summary of the second report of the National Cholesterol Education program (NCEP) expert panel. JAMA. 1993; 269:3015.Google Scholar
  68. 68.
    The writing group for the PEPI Trial: Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: The postmenopausal Estrogen/Progestin Intervention(PEPI) Trial. JAMA. 1995; 273:199.Google Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • V. Rajkumar
    • 1
  • Luis C. Afonso
    • 1
  • Joel Steinberg
    • 1
  • Stephen L. Farrow
    • 1
  • James R. Sowers
    • 1
  1. 1.Wayne State University School of MedicineDetroitUSA

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