Screening for hypertension-mediated organ damage and aetiology: Still of value after 65 years of age?

Abstract

Pathophysiological aspects and the consequences of hypertension may differ between younger and older patients. The aim of the present study was to explore the specificity of hypertension-mediated organ damage (HMOD) and secondary forms in patients ≥ 65 years in comparison to younger ones in a contemporary cohort. A total of 938 hypertensive patients who had at baseline HMOD and secondary forms screening were included among them 190 were ≥ 65 years. The mean ± SD number (2.1 ± 0.8 vs. 1.2 ± 0.9, P < 0.001) and frequency of HMOD (96.3% vs. 72.9%, P < 0.001) was higher in patients ≥ 65 years than younger ones. Carotid femoral pulse wave velocity > 10 m/s was the most frequent HMOD in patients ≥ 65 years (90.1%), while echocardiographic left ventricular hypertrophy was the most common in the younger patients (45.0%). Among ECG left ventricular ECG indexes, only R wave in aVL lead was significantly more frequently observed in patients ≥ 65 years (32.6%) than in younger ones (19.0%, P < 0.001). The frequency of secondary hypertension was not significantly different between younger and older patients (respectively; 30.5% vs. 27.8%, P = 0.487). The most frequent aetiology was primary aldosteronism regardless of age. The frequency of renovascular hypertension was higher in patients ≥ 65 years (6.3% vs. 3.3%, P = 0.038). Among older patients, 3.2% were treated with adrenalectomy (primary aldosteronism or Cushing syndrome) and 6.3% with percutaneous transluminal renal angioplasty. In a tertiary centre, secondary forms of hypertension have a similar frequency in both subgroups. Extensive screening of HMOD in patients aged ≥ 65 years may be questionable because of its very high frequency.