Cardiovascular care for older adults: hypertension and stroke in the older adult.

Abstract

Hypertension and cerebrovascular disease incidence and prevalence rise dramatically with age, owing to longer exposure time to age-associated alterations in vascular function and structure and cardiovascular risk factors. This chapter is aimed at connecting age-related alterations in vascular function and structure to the resultant target organ damage, and to raise awareness of unique presentations and treatment strategies for hypertension and stroke in older adults. Much of this chapter builds on the unique physiology of the older adult, as previously described by Dai, et al.,[1] and applied to the conditions of hypertension and stroke here. Arterial changes with aging include increased calcium deposition, collagen content, and collagen cross-linking, increased intima-media thickness, increased reactive oxygen species and a pro-inflammatory state and increased apoptosis of vascular smooth muscle cells. These changes lead to stiffer vessels that demonstrate less systolic compliance and diastolic elasticity, increased pulse wave velocity, and increased pulse pressure. The early reflected wave and augmented systolic pressure characteristic of arterial stiffness create greater demands on the left ventricle, resulting in left ventricular hypertrophy and impaired relaxation, which ultimately lead to increased left atrial pressure and size. Coupled with changes in endothelial function, neurohormonal regulation and renal function, these hemodynamic processes create the unique physiology of the older adult, manifest by isolated systolic hypertension, target organ damage and cardiovascular disease (CVD).