Hypertension in old age:
Excessive blood pressure reduction increases coronary risk
Berlin - With advancing age the major blood vessels undergo
structural and functional changes. This is why elderly persons tend
to suffer from isolated systolic hypertension, a special form of
hypertension that is frequently difficult to treat with drugs. Moreover,
reducing blood pressure too much in elderly persons suffering
at the same time from coronary disease may even be dangerous,
warn experts ahead of the International Hypertension Congress
2008 in Berlin.
Any form of hypertension increases the coronary and stroke risk in the
long term. For doctors, therefore, there is no question that this condition
does require treatment. "Isolated systolic hypertension is at the root of the
majority of hypertension disorders in the over-sixties age group,"
comments Professor Dr. med. Rainer Düsing of the Medical Polyclinic I at
Bonn's University Clinic. Persons with diabetes mellitus, elevated blood
lipid levels or kidney disorders, as well as smokers, are particularly at
risk. But persons with diastolic hypertension - the form of hypertension
most prevalent in younger persons - frequently develop systolic
hypertension in old age as well. "Older persons, in particular, should be
sure to check their blood pressure regularly and seek treatment if it is
higher than it should be," advises Düsing. In cases of this kind the choice
of blood-pressure reducing drug is decisive for the progression of the
disease, for many drugs also reduce the lower, diastolic blood pressure,
which is often low in persons with isolated systolic hypertension. A drop
to below the normal value can, however, present risks for patients
already suffering from coronary heart disease. A study of patients with
pre-existing coronary heart disease has shown that reducing the diastolic
value to less than 70-80 mmHg increases the risk of myocardial
infarction. "We therefore check blood pressure regularly and preferentially
use drugs that have been proven to be effective and safe in large-scale
studies on elderly people with isolated hypertension," adds Düsing.
the
Windkessel function of the aorta. "The result is a marked rise in the
upper, systolic blood pressure value, while the lower, diastolic value is
only slightly elevated, or even normal," explains Düsing. For doctors the
clue to diagnosing isolated systolic hypertension is increased pulse
pressure, namely the difference between the systolic and the diastolic
blood pressure. Normally, it is 40 mmHg, but may be significantly higher
in old age.
PLEASE NOTE: Official Press Conferences (during the Congress)
