Essential hypertension in the elderly: haemodynamics, intravascular volume, plasma renin activity, and circulating catecholamine levels.

In an attempt to dissociate the cardiovascular adaptations to high blood pressure from those of ageing, 30 patients with established essential hypertension aged over 65 years were matched for mean arterial pressure, race, sex, height, and weight with 30 patients younger than 42 years. Cardiac output, heart rate, stroke volume, intravascular volume, renal blood flow, and plasma renin activity were significantly lower in the elderly, whereas total peripheral (and renal vascular) resistance, left ventricular posterior wall and septal thicknesses, and left ventricular mass were higher. Intravascular volume correlated inversely with total peripheral resistance in both groups and in all patients. Pathophysiological findings of essential hypertension in the elderly are characterised by a hypertrophied heart of the concentric type with a low cardiac output resulting from a smaller stroke volume and a slower heart rate. Renal blood flow is disproportionally reduced and total peripheral and renal vascular resistance elevated.

Diurnal variations of cardiac rhythm, arterial pressure, and urinary catecholamines in borderline and established essential hypertension.

Ambulatory continuous ECG and arterial pressure (BP) were recorded simultaneously (Delmar Avionics Pressurometer II) for 24 hours in 13 age-matched normotensive subjects, 11 patients with borderline hypertension (HBP), and in 10 patients with uncomplicated established essential HBP. Urinary concentrations of epinephrine, norepinephrine, and dopamine were simultaneously collected over four successive 4-hour periods and one 8-hour period. Prevalence and total number of ventricular and supraventricular ectopic beats was low and not affected by arterial BP. Twenty-four-hour rate (HR) and 4-hourly excretion of epinephrine, norepinephrine, and dopamine were comparable between normotensive and HBP persons and no correlation between urinary catecholamines and arterial BP (systolic, diastolic, or mean), HR, or prevalence of ectopic beats was found in any of the three groups or in the total study population. We conclude that HBP patients without ECG evidence of left ventricular hypertrophy do not have a higher prevalence of supraventricular or ventricular ectopic beats. Urinary catecholamines are not related to circadian fluctuations or variability in arterial BP, HR, or prevalence of ectopic beats.

Hypertension in the elderly: haemodynamic, fluid volume and endocrine findings.

1. Systemic and renal haemodynamics, intravascular volume, circulating catecholamines and plasma renin activity were measured in 18 patients with established essential hypertension who were older than 60 years of age. Each patient was matched with respect to mean arterial pressure, body surface area, race and sex with a patient that was younger than 42 years of age. 2. When compared with the younger group, elderly patients had a lower cardiac output, impaired myocardial reserve, lesser aortic elasticity, higher total peripheral resistance, more contracted intravascular volume and higher circulating noradrenaline levels. 3. Similar effects of age, although less pronounced, have been reported in normotensive subjects. We conclude that essential hypertension is a pathophysiological process that seems to accelerate the natural physiological haemodynamic, fluid volume and endocrine processes of aging.