ABSTRACT
Hypertension among the elderly generally represents a salt- sensitive state. However this salt-sensitivity does not appear to result from age-related increase in either sodium or salt intake. Since 20 years new trends seem to relate the role of sodium in the genesis of hypertension to a primary abnormality of electrolyte transport of cell membrane. Lipid abnormalities have also been described in untreated patients with high blood pressure. Plasma triglycerides were considerably higher (p < 0.01) in the hypertensives than in the controls. 24 hour sodium excretion was significantly lower (p < 0.0001) in hypertensives than in the controls. We have found a strong correlation among reduced sodium excretion, higher triglycerides and elevated blood pressure in the elderly. The blood pressure correlated negatively with 24 hour sodium excretion (p < 0.0001 for systolic and p < 0.002 for diastolic) and positively with plasma triglycerides (p < 0.0001 for systolic and p < 0.001 for diastolic). The poor literature regarding an association of these two alterations in human hypertensives makes our results provocative. We speculated that these alterations may be a facet of the insulin resistance commonly detectable in human hypertensives. However, further investigations are required to answer to this intriguing hypothesis.
Subject(s)
Hypertension/physiopathology , Sodium/urine , Triglycerides/blood , Aged , Blood Glucose/metabolism , Blood Pressure/drug effects , Cell Membrane/metabolism , Drug Resistance , Female , Humans , Hypertension/etiology , Ion Transport , Natriuresis , Sodium Chloride, Dietary/adverse effectsABSTRACT
Hypertension is the leading cause of death in the elderly in Western countries. The Authors remark that hypertension is not only a purely hemodynamic phenomenon, but is a multifaceted disease frequently associated with metabolic disorders in the elderly. Among the latter, hyperinsulinism could be the linking pathogenetic factor with atherosclerosis progression. Then the Authors suggest a unitary pathogenetic hypothesis of hypertension and atherosclerosis. The crucial points are the inborn alteration of cellular sodium transport systems and the modulating action of environmental factors, first of all insulin. According to this hypothesis, the goal of the management of elderly hypertensives is the prevention of the fatal or invalidant cerebro- and cardiovascular event. To follow a good "pathogenetic" treatment of elderly hypertension and atherosclerotic process evolution, the first step is a dietetic approach avoiding acute load of sodium and lipids. Furthermore, the pharmacological treatment with calcium antagonists and ACE inhibitors is respectful of associated metabolic disorder and positively modulate the cellular sodium transport systems activity.
Subject(s)
Aging/physiology , Arteriosclerosis/etiology , Arteriosclerosis/therapy , Hypertension/etiology , Hypertension/therapy , Aged , Cardiovascular Diseases/etiology , Humans , Risk Factors , Sodium/physiologyABSTRACT
Malnutrition is a common disorder in the elderly. Its incidence is underestimated, although its relevance to a prolonged hospitalization and/or a poor prognosis is recognized. The aim of this study was to identify a true and economic biochemical marker of malnutrition, and to assess its relevance to the prognosis and social costs of prolonged hospitalization. Serum albumin and lymphocyte counts were significantly inferior in the elderly group (p<0.01). Nevertheless, elderly patients usually do not undergo a prolonged hospitalization, only those having serum albumin <3.5% and lymphocyte counts <1500/mm(3) showed a significantly longer hospitalization (p<0.01).
