Cardiologia Croatica, Vol. 7 No. 7-8, 2012.
Review article
Hypertension in the elderly
Borka Božić
; Clinical Hospital Dubrava, Zagreb, Croatia
Ivan Durlen
; Clinical Hospital Dubrava, Zagreb, Croatia
Mario Pehar
; Clinical Hospital Dubrava, Zagreb, Croatia
Ivana Matešić
; Clinical Hospital Dubrava, Zagreb, Croatia
Krešimir Galešić
; Clinical Hospital Dubrava, Zagreb, Croatia
Abstract
Hypertension in the elderly is a major public health problem due to high prevalence and the world population ageing trend. Most often it is the isolated systolic hypertension (90% of patients over 70 years of age) that is concerned. Furthermore, pulse pressure and systolic pressure are the most important risk factors in elderly persons. Pathophysiologically, there is a great number of structural (loss of elasticity of large blood vessels, decreased elasticity, increased pulse wave velocity) and functional (endothelial dysfunction, decreased sensitivity of beta receptors, decreased baroreceptor function, sensitivity to salt) changes in the background. Treatment of hypertension in the elderly has so far been a big challenge, because there were not enough studies that have dealt with this population. Now this has changed after results of the HYVET study have been published. HYVET study included the oldest patients (above 80 years of age) and has proven that lowering pressure by 15/6 mmHg, leads to significantly lower overall mortality (21%), cardiovascular mortality (23%), incidence of stroke (30%) and heart failure (64%). We emphasize thiazide diuretic as the first choice drug in the elderly population, and since these patients usually require multiple treatment, we emphasize calcium channel blockers or ACE inhibitors. Comorbidities, naturally, determine the basic or additional therapy.
Keywords
hypertension; elderly persons; diuretics
Hrčak ID:
84923
URI
Publication date:
23.7.2012.
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