Abstract P143: Pulsatile Stress in the Hypertensive Elderly versus Young Patients

Abstract

Background: Hypertensive patients suffer wide pulse pressure (PP) with age, an independent marker of cardiac events. Changes in the heart rate (HR) may decrease pulsatile stress (PPxHR). Objectives: To examine pulsatile stress in hypertensive elderly patients, as a potential compensatory mechanism to widened pulse pressure. Methods: Clinic charts were reviewed with hypertension as a diagnosis; 200 encounters were reviewed and divided into 2 groups; group 1 (young) were patients < 60 years of age (n=116), and group 2 (elderly) were patient ≥ 60 years of age (n=84). The difference between the groups with regards systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), heart rate (HR), and pulsatile stress (PPxHR) were analyzed using Student’s t-Test. Results: The mean age of patients was 68±9 years in elderly versus (VS) 49±9 years in the young. SBP was marginally higher in the elderly at 134±20 vs 128±18 mmHg in the young; P = 0.04. DBP and HR were significantly lower in the elderly vs the young at 80±13 vs 86±13 mmHg, and 67±11 vs 76±14 BPM respectively; P < 0.01. PP was significantly higher in the elderly at 55±18 vs 42±13 mmHg in the young; P < 0.01. Pulsatile stress (PPxHR), however, was not significantly different in the elderly at 3,795±1,506 vs 3,477±1,246 in the young; P = 0.11. Discussion: Elderly patients suffer elevated pulse pressure, an independent predictor of cardiac risk. In our cohort, the pulse pressure was significantly higher, as expected, in elderly patients. However, the heart rate in elderly patients was significantly lower, therefore causing no significant difference in the pulse pressure-heart rate product (a measure of pulsatile stress) compared with younger patients. Overall, the medical management in our cohort was guideline-based and was not significantly different among the two groups. Whether the slower heart rate seen in elderly patients is compensatory, or merely a manifestation of intrinsic sinus node disease is unclear. Further studies to compare the response of pulsatile stress to exercise in elderly versus younger patients may help clarify this issue.