Pulsatile hemodynamics and cardiovascular risk factors in very old patients: background, sex aspects and implications.
(2013) In Journal of Hypertension 31(5). p.848-857- Abstract
- BACKGROUND:: In the nineteenth century, prior to the introduction of the cuff sphygmomanometer, stiffening of arteries was recognized as an indicator of vascular ageing and cardiovascular risk. Through the twentieth century, views on vascular ageing came to focus on brachial blood pressures and on occlusive atherosclerotic disease. Such focus deflected attention from primary ageing changes, represented by stiffening and dilation of the proximal aorta. AIM:: This review emphasizes the cushioning function of elastic arteries, principally the aorta, now when life expectancy largely exceeds 80 years providing new challenges for medical treatment in the very old. METHODS AND RESULTS:: First, life expectancy has increased significantly for both... (More)
- BACKGROUND:: In the nineteenth century, prior to the introduction of the cuff sphygmomanometer, stiffening of arteries was recognized as an indicator of vascular ageing and cardiovascular risk. Through the twentieth century, views on vascular ageing came to focus on brachial blood pressures and on occlusive atherosclerotic disease. Such focus deflected attention from primary ageing changes, represented by stiffening and dilation of the proximal aorta. AIM:: This review emphasizes the cushioning function of elastic arteries, principally the aorta, now when life expectancy largely exceeds 80 years providing new challenges for medical treatment in the very old. METHODS AND RESULTS:: First, life expectancy has increased significantly for both sexes and is particularly prolonged after menopause. Second, phenotypic changes are noticed such as that the age-related increase of waist circumference and hyperlipidemia is markedly slowed, whereas the concomitant rise in C-reactive protein is enhanced and hyperglycaemia develops in many patients. Third, the systolic, diastolic and pulse pressures rise with age is attenuated or even stopped, as is the degree of arterial stiffness. Finally, in very old patients, the main causes of death are cardiovascular, including cardiac deaths, which differ markedly by causation in men (due to lowered ejection fraction) and women (due to arrhythmia disorders). Deaths associated with renal impairment are observed in both sexes. CONCLUSION:: No simple linear relationships exist between all these phenotypic variables and the ageing process. Treatment goals of hypertension and diabetes mellitus remain difficult to predict from such data. Prevention of cardiovascular risk in the very old is thus influenced by limited evidence and important ethical considerations. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/3628742
- author
- Safar, Michel E and Nilsson, Peter LU
- organization
- publishing date
- 2013
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Hypertension
- volume
- 31
- issue
- 5
- pages
- 848 - 857
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- wos:000317115000001
- pmid:23449020
- scopus:84876298705
- pmid:23449020
- ISSN
- 1473-5598
- DOI
- 10.1097/HJH.0b013e32835ed5b9
- language
- English
- LU publication?
- yes
- id
- 76eca94a-e769-4a5a-ac59-d8418cad0775 (old id 3628742)
- alternative location
- http://www.ncbi.nlm.nih.gov/pubmed/23449020?dopt=Abstract
- date added to LUP
- 2016-04-01 10:35:16
- date last changed
- 2022-02-25 03:12:03
@article{76eca94a-e769-4a5a-ac59-d8418cad0775,
abstract = {{BACKGROUND:: In the nineteenth century, prior to the introduction of the cuff sphygmomanometer, stiffening of arteries was recognized as an indicator of vascular ageing and cardiovascular risk. Through the twentieth century, views on vascular ageing came to focus on brachial blood pressures and on occlusive atherosclerotic disease. Such focus deflected attention from primary ageing changes, represented by stiffening and dilation of the proximal aorta. AIM:: This review emphasizes the cushioning function of elastic arteries, principally the aorta, now when life expectancy largely exceeds 80 years providing new challenges for medical treatment in the very old. METHODS AND RESULTS:: First, life expectancy has increased significantly for both sexes and is particularly prolonged after menopause. Second, phenotypic changes are noticed such as that the age-related increase of waist circumference and hyperlipidemia is markedly slowed, whereas the concomitant rise in C-reactive protein is enhanced and hyperglycaemia develops in many patients. Third, the systolic, diastolic and pulse pressures rise with age is attenuated or even stopped, as is the degree of arterial stiffness. Finally, in very old patients, the main causes of death are cardiovascular, including cardiac deaths, which differ markedly by causation in men (due to lowered ejection fraction) and women (due to arrhythmia disorders). Deaths associated with renal impairment are observed in both sexes. CONCLUSION:: No simple linear relationships exist between all these phenotypic variables and the ageing process. Treatment goals of hypertension and diabetes mellitus remain difficult to predict from such data. Prevention of cardiovascular risk in the very old is thus influenced by limited evidence and important ethical considerations.}},
author = {{Safar, Michel E and Nilsson, Peter}},
issn = {{1473-5598}},
language = {{eng}},
number = {{5}},
pages = {{848--857}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Journal of Hypertension}},
title = {{Pulsatile hemodynamics and cardiovascular risk factors in very old patients: background, sex aspects and implications.}},
url = {{http://dx.doi.org/10.1097/HJH.0b013e32835ed5b9}},
doi = {{10.1097/HJH.0b013e32835ed5b9}},
volume = {{31}},
year = {{2013}},
}