Evolution of hypertension and diabetes in elderly subjects

Abstract

Hypertension (HTA) is common in elderly diabetic patients, who are at risk of cardiovascular complications and accelerated degenerative disease. We aimed to determine the characteristics of hypertension and diabetes in the elderly. We collected all the records of elderly diabetic and hypertensive patients hospitalized at least once in our department of endocrinology-internal medicine from 2010 to 2018. Fifty-nine patients were identified. The average age was 70.77 years (65–84 years). The sex ratio was 1.56 (F/H) with 36 women and 23 men. The seniority of diabetes was 8.18 years (1–30). The diagnosis of diabetes preceded that of hypertension in 16 cases (27.11%) with 67.79% of insulin treated patients and 32.21% received oral antidiabetic agents. Fifty-six percent of the patients had Grade I hypertension, 70% of whom were systolic with treatment with at least one bitherapy in 28 (47.45%); the most frequent combination was ACE (inhibitors conversion enzyme) and diuretics. Mean BMI was 32.93 kg/m2 (24–50.44). The dyslipidemia was present in 34 patients (57,62%) with essentially a hyper-triglyceridemia (70%). Macroangiopathy was observed in 19 patients (32.2%) with mainly ischemic heart disease (30%) significantly more often in patients with HbA1c > 8.5% and LDL > 1 g/L. Microangiopathy was present in 30 cases (50.84%) with diabetic retinopathy in 40.2% of patients and diabetic neuropathy in 21.4%. Regarding the non-degenerative complications of diabetes, this age group was mainly exposed to infectious complications with a clear predominance of urinary infection and non-necrotizing dermo-hypodermitis (8.47% of cases). Comprehensive management of cardiovascular risk factors in elderly patients is needed to improve the quality of life of these frail patients. On the other hand, poly-pathology and polypharmacy is a source of poor compliance and therefore unsatisfactory evolution.