Skip to main content
SpringerLink
Log in

Cerebral blood flow in the elderly: Impact of hypertension and antihypertensive treatment

  • Cerebral Blood Flow, Cardiovascular Reflexes, and Respiratory Function
  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Summary

The subject of the cerebral circulation in the elderly is reviewed. In old age, cerebral blood flow (CBF), which is closely coupled to cerebral oxidative metabolism, decreases along with the amount of brain tissue. In healthy old people, the cerebral circulation is regulated as earlier in life, by autoregulation, metabolic regulation, and chemical and other factors. CBF and its regulation is influenced by disease processes prevailing in old age, such as dementia, atherosclerosis, diabetes mellitus, stroke, and hypertension. Hypertension, apart from being a risk factor for stroke, causes adaptive cerebral vascular changes, leading to a shift of the lower limit of autoregulation towards high pressure, with an impaired tolerance to pressure decrease. In old age, this adaptation may not be reversible. With this background, a conservative approach to elderly hypertensive patients is suggested, aimed at some reduction of pressure but carefully avoiding overtreatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gottstein U. Interne Therapie der Alternsprozesse des Gehirns und seiner Gefässe. Wein Klin Wschr 1969;81:441–446.

    Google Scholar 

  2. Meyer CHA, Lowe D, Meyer M, et al. Subarachnoid hemorrhage: Older patients have low cerebral blood flow. Br Med J 1982;2:1149–1153.

    Google Scholar 

  3. Mazziotta JC, Phelps ME. Human sensory stimulation and deprivation: Positron emission tomographic results and strategies. Ann Neurol 1984;15(Suppl):S50-S60.

    Google Scholar 

  4. Fencl V, Vale JR, Broch JA. Respiration and cerebral blood flow in metabolic acidosis and alkalosis in humans. J Appl Physiol 1969;27:67–76.

    Google Scholar 

  5. Paulson OB, Newman EA. Does the release of potassium from astrocyte endfeet regulate cerebral blood flow? Science 1987;237:896–898.

    Google Scholar 

  6. Winn HR, Welsh JE, Rubio R, Berne RM. Brain adenosine production in rat during sustained alteration in systemic blood pressure. Am J Physiol 1980;239 (Heart Circ Physiol 8):H636-H641.

    Google Scholar 

  7. Lassen NA. Cerebral blood flow and oxygen consumption in man. Physiol Rev 1959;39:183–238.

    Google Scholar 

  8. Heistad DD, Kontos HA. Cerebral circulation. In: Shepherd JT, Abbourd FM, eds. Handbook of physiology. Section 2. The Cardiovascular System, Vol. 3. Bethesda: American Physiological Society, 1983;137–182.

    Google Scholar 

  9. Häggendal A, Johanson B. Effects of arterial carbon dioxide tension and oxygen saturation on cerebral blood flow autoregulation in dogs. Acta Physiol Scand 1965;66(Suppl 258):27–53.

    Google Scholar 

  10. Olesen J. The effect of intracarotid epinephedrine, norepinephrine and angiotensin on the regional cerebral blood flow in man. Neurology 1972;22:978–987.

    Google Scholar 

  11. Hamar J, Kovach ABG, Reivich M, et al. Effect of phenoxybenzamine on cerebral blood flow and metabolism in the baboon during haemorrhagic shock. Stroke 1979;10:401–407.

    Google Scholar 

  12. Beausang-Linder M, Bill A. Cerebral circulation in acute arterial hypertension—protective effects of sympathetic nervous activity. Acta Physiol Scand 1981;III:193–199.

    Google Scholar 

  13. Edvinsson L. Neurogenic control of cerebral circulation. In: Hartman A, Kuschinsky W, eds. Cerebral ischemia and hemorheology. Springer-Verlag, Berlin, 1987:13–23.

    Google Scholar 

  14. Barry DI, Jarden JO, Paulson OB, et al. Cerebrovascular effects of converting enzyme inhibition. I: Effects of intravenous captopril in spontaneously hypertensive and normotensive rats. J Hypertens 1984;2:589–597.

    Google Scholar 

  15. Paulson OB, Jarden JO, Vorstrup A, et al. Effect of captopril on the cerebral circulation in chronic heart failure. Eur J Clin Invest 1986;16:124–132.

    Google Scholar 

  16. Paulson OB, Parving H-H, Olesen J, Skinhøj E. Influence of carbon monoxide and of hemodilution on cerebral blood flow and blood gases in man. J Appl Physiol 1973;35:111–116.

    Google Scholar 

  17. Simard D, Olesen J, Paulson OB, et al. Regional cerebral blood flow and its regulation in dementia. Brain 1971;94:273–278.

    Google Scholar 

  18. Wollner L, McCarthy ST, Soper NDW, Macy DJ. Failure of cerebral autoregulation as a cause of brain dysfunction in the elderly. Br Med J 1979;1:1117–1118.

    Google Scholar 

  19. Bentsen N, Larsen B, Lassen NA. Chronically impaired autoregulation of cerebral blood flow in long-term diabetics. Stroke 1975;6:497–502.

    Google Scholar 

  20. Ruff RL, Talman WT, Petito F. Transient ischemic attacks associated with hypotension in hypertensive patients with carotid artery stenosis. Stroke 1981;12:353–355.

    Google Scholar 

  21. Olsen TS. Regional cerebral blood flow after occlusion of the middle cerebral artery. Acta Neurol Scand 1986;73:321–337.

    Google Scholar 

  22. Paulson OB. Cerebral apoplexy (stroke). Pathogenesis, pathophysiology and therapy as illustrated by regional blood flow measurements in brain. Stroke 1971;2:327–360.

    Google Scholar 

  23. Strandgaard S. Autoregulation of cerebral blood flow in hypertensive patients. The modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension. Circulation 1976;53:720–727.

    Google Scholar 

  24. Jones JV, Fitch W, MacKenzie ET, et al. Lower limit of cerebral blood flow autoregulation in experimental renovascular hypertension in the baboon. Circ Res 1976;39:555–557.

    Google Scholar 

  25. Barry DI, Strandgaard S, Graham DI, et al. Cerebral blood flow in rats with renal and spontaneous hypertension: Resetting of the lower limit of autoregulation. J Cereb Blood Flow Metab 1982;2:347–353.

    Google Scholar 

  26. Folkow B. The haemodynamic consequences of adaptive structural changes in the resistance vessels in hypertension. Clin Sci 1971;41:1–12.

    Google Scholar 

  27. Vorstrup S, Barry DI, Jarden JO, et al. Chronic antihypertensive treatment reverses the hypertension-induced changes in cerebral blood flow autoregulation. Stroke 1984;15:312–318.

    Google Scholar 

  28. Shekelle RB, Ostfeld AM, Klawans HL. Hypertension and risk of stroke in an elderly population. Stroke 1974;5:71–76.

    Google Scholar 

  29. Amery A, Brixko P, Clement D, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly. Lancet 1985;1:1349–1354.

    Google Scholar 

  30. Dahlöf B, Hansson L, Lindholm L, et al. STOP-Hypertension—preliminary communication from the pilot study of the Swedish Trial in Old Patients with Hypertension. J Hypertens 1985;5(Suppl 5):S607-S610.

    Google Scholar 

  31. Jackson G, Pierscianowski TA, Mahon W, Condon J. Inappropriate antihypertensive therapy in the elderly. Lancet 1976;2:1317–1318.

    Google Scholar 

  32. Jansen PAF, Gribnau FWJ, Schultz BPM, Poels EFJ. Contribution of inappropriate treatment for hypertension to pathogenesis of stroke in the elderly. Br Med J 1986; 293:914–917.

    Google Scholar 

  33. Cruickshank JM, Higgins TJC, Pennert K, et al. The efficacy and tolerability of antihypertensive treatment based on atenelol in the prevention of stroke and the regression of left ventricular hypertrophy. J Human Hypertens 1987; 1:87–93.

    Google Scholar 

  34. Samuelsson O, Wilhelmsen L, Andersson OK, et al. Cardiovascular morbidity in relation to change in blood pressure and serum cholesterol levels in treated hypertension. Results from the primary prevention trial in Göteborg, Sweden. JAMA 1987;258:1768–1776.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine and Nephrology B, Herlev Hospital, Herlev, Denmark

    Svend Strandgaard

Authors
  1. Svend Strandgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Strandgaard, S. Cerebral blood flow in the elderly: Impact of hypertension and antihypertensive treatment. Cardiovasc Drug Ther 4 (Suppl 6), 1217–1221 (1991). https://doi.org/10.1007/BF00114223

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00114223

Key Words

Search

Navigation