Aging and Blood Pressure

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Systolic hypertension is an acquired, age-related characteristic that has moderate and variable genetic contribution [11-15] but aging is not inexorably associated with systolic hypertension. In primitive or cloistered societies, there are no relations between age and BP and the incidence of hypertension at any age is very low [16, 17]. In industrialized societies, complex relations between age and BP are found (fig. 1) [6, 18], where systolic BP increases linearly with age, while diastolic BP increases until about age 50 then declines. Mean arterial pressure (MAP) increases until about age 50 then plateaus, while PP is constant until age 50 then increases. In adults, systolic hypertension is thus the predominant form of the condition and the percent with diastolic hypertension rapidly dwindles with aging. Furthermore, systolic hypertension is not a

Fig. 2. Pathogenesis of systolic and diastolic BP elevations. Increased systemic vascular resistance (SVR) causes parallel elevations in diastolic, mean arterial, and systolic BP. Rarely, increased left ventricular (LV) stroke volume can cause elevated systolic BP. The determinant of wide pulse pressure is increased aortic impedance, either due to a smaller aortic diameter or increased effective wall stiffness. At older ages, high aortic impedance is usually associated with wide pulse pressure due to increased aortic stiffness, which acts to reduce diastolic BP even when SVR is moderately elevated (see text).

Fig. 2. Pathogenesis of systolic and diastolic BP elevations. Increased systemic vascular resistance (SVR) causes parallel elevations in diastolic, mean arterial, and systolic BP. Rarely, increased left ventricular (LV) stroke volume can cause elevated systolic BP. The determinant of wide pulse pressure is increased aortic impedance, either due to a smaller aortic diameter or increased effective wall stiffness. At older ages, high aortic impedance is usually associated with wide pulse pressure due to increased aortic stiffness, which acts to reduce diastolic BP even when SVR is moderately elevated (see text).

consequence of longstanding diastolic hypertension, as once thought. Systolic hypertension arises de novo at any age, and often preceding diastolic hypertension [6]. What is usually different from a pathophysiologic viewpoint is that the underlying hemodynamic mechanisms of systolic BP elevation and wide PP vary considerably as systolic hypertension presents itself in various clinical populations.

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