Skip to main content
SpringerLink
Log in

Hypertension in the Elderly: Pathophysiology and Clinical Significance

  • Chapter
  • First Online:
Hypertension and Cardiovascular Disease in Asia

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

Abstract

The population in Asia has been rising since 2000 and is estimated to reach 932 million in 2050, making Asia the most populous elderly region in the world. The prevalence of hypertension is high even in Asia and it rises with age. In tandem with the aging population, Asia will have the largest population with hypertension in the world by the middle of this century.

While several of the mechanisms and pathophysiology responsible for the causation of hypertension are similar to younger adults, many differences also occur. The elderly have more arterial stiffness leading to a greater elevation of systolic blood pressure (BP) than the diastolic BP, resulting in a higher prevalence of isolated systolic hypertension which is more difficult to treat. The elderly is also more salt-sensitive and herein opportunities and evidence exist that lowering salt intake can lower BP. Evidence has also emerged that the white coat effect and masked hypertension are more common in the elderly and should be identified as they are associated with increased cardiovascular (CV) risk.

Hypertension in the elderly needs to be treated as reducing BP reduces CV mortality and morbidity. However, because the elderly is a more vulnerable group, usually having many other co-morbid conditions, including functional and cognitive impairments. Treatment may increase the occurrence of postural hypotension potentially leading to falls; thus, any treatment for the elderly has to be individualized. Target BP control for the elderly has to balance the benefits and adverse effects of anti-hypertensive therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. WHO. Ageing and health fact sheet. WHO Publication. 2018. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 9 Aug 2021.

  2. Department of Economic and Social Affairs, Population Division, United Nations. World Population Prospects 2019. https://population.un.org/wpp/. Accessed 9 Aug 2021.

  3. Population and aging in Asia: the growing elderly population. Asia Development Bank. 2018. https://data.adb.org/dataset/population-and-aging-asia-and-pacific. Accessed 9 Aug 2021.

  4. WHO. Hypertension fact sheet. WHO Publication. 2021. https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 9 Aug 2021.

  5. CDC. Prevalence of select measures among adults aged 20 and over: United States, 1999–2000 through 2017–2018. NHANES Interactive Data Visualizations. 2018. https://www.cdc.gov/nchs/nhanes/visualization/. Accessed 9 Aug 2021.

  6. Chia Y-C, Buranakitjaroen P, Chen C-H, Divinagracia R, Hoshide S, Park S, et al. Current status of home blood pressure monitoring in Asia: statement from the HOPE Asia Network. J Clin Hypertens. 2017;19(11):1192–201.

    Article  Google Scholar 

  7. Malaysia National Health and Morbidity Survey 2015. Non-communicable diseases, risk factors and other health related problems, Vol. II. Ministry of Health Malaysia. 2015. http://www.moh.gov.my/moh/resources/nhmsreport2015vol2.pdf. Accessed 9 Aug 2021.

  8. Pakistan Health Research Council. Non-communicable Diseases Risk Factors Survey––Pakistan. Islamabad: World Health Organization; 2016. ISBN 978-969-499-008-8.

    Google Scholar 

  9. Kario K, Wang J-G. Could 130/80 mmHg be adopted as the diagnostic threshold and management goal of hypertension in consideration of the characteristics of Asian populations? Hypertension. 2018;71(6):979–84.

    Article  CAS  PubMed  Google Scholar 

  10. Ueshima H, Sekikawa A, Miura K, Turin TC, Takashima N, Kita Y, et al. Cardiovascular disease and risk factors in Asia: a selected review. Circulation. 2008;118(25):2702–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia. 2006;49(11):2580–8.

    Article  CAS  PubMed  Google Scholar 

  12. Dou L, Liu X, Zhang T, Wu Y. Health care utilization in older people with cardiovascular disease in China. Int J Equity Health. 2015;14(1):59.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Coffman TM. The inextricable role of the kidney in hypertension. J Clin Invest. 2014;124(6):2341–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Coffman TM, Crowley SD. Kidney in hypertension. Hypertension. 2008;51(4):811–6.

    Article  CAS  PubMed  Google Scholar 

  15. Bidani AK, Griffin KA. Pathophysiology of hypertensive renal damage. Hypertension. 2004;44(5):595–601.

    Article  CAS  PubMed  Google Scholar 

  16. Hall JE, Granger JP, do Carmo JM, da Silva AA, Dubinion J, George E, et al. Hypertension: physiology and pathophysiology. Compr Physiol. 2012;2(4):2393–442.

    Article  PubMed  Google Scholar 

  17. Kotchen TA. Historical trends and milestones in hypertension research. Hypertension. 2011;58(4):522–38.

    Article  CAS  PubMed  Google Scholar 

  18. Sever PS, Messerli FH. Hypertension management 2011: optimal combination therapy. Eur Heart J. 2011;32(20):2499–506.

    Article  PubMed  Google Scholar 

  19. Zhao D, Liu H, Dong P, Zhao J. A meta-analysis of add-on use of spironolactone in patients with resistant hypertension. Int J Cardiol. 2017;233:113–7.

    Article  PubMed  Google Scholar 

  20. Wang C, Xiong B, Huang J. Efficacy and safety of spironolactone in patients with resistant hypertension: a meta-analysis of randomised controlled trials. Heart Lung Circ. 2016;25(10):1021–30.

    Article  PubMed  Google Scholar 

  21. Williams B, MacDonald TM, Morant SV, Webb DJ, Sever P, McInnes GT, et al. Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies. Lancet Diabet Endocrinol. 2018;6(6):464–75.

    Article  Google Scholar 

  22. Weidmann P, De Myttenaere-Bursztein S, Maxwell MH, de Lima J. Effect on aging on plasma renin and aldosterone in normal man. Kidney Int. 1975;8(5):325–33.

    Article  CAS  PubMed  Google Scholar 

  23. Bauer JH. Age-related changes in the renin-aldosterone system. Physiological effects and clinical implications. Drugs Aging. 1993;3(3):238–45.

    Article  CAS  PubMed  Google Scholar 

  24. Messerli FH, Sundgaard-Riise K, Ventura HO, Dunn FG, Glade LB, Frohlich ED. Essential hypertension in the elderly: haemodynamics, intravascular volume, plasma renin activity, and circulating catecholamine levels. Lancet. 1983;2(8357):983–6.

    Article  CAS  PubMed  Google Scholar 

  25. Duprez DA, Munger MA, Botha J, Keefe DL, Charney AN. Aliskiren for geriatric lowering of systolic hypertension: a randomized controlled trial. J Hum Hypertens. 2010;24(9):600–8.

    Article  CAS  PubMed  Google Scholar 

  26. Mimran A, Ribstein J, Jover B. Aging and sodium homeostasis. Kidney Int Suppl. 1992;37:S107–13.

    CAS  PubMed  Google Scholar 

  27. Epstein M, Hollenberg NK. Age as a determinant of renal sodium conservation in normal man. J Lab Clin Med. 1976;87(3):411–7.

    CAS  PubMed  Google Scholar 

  28. Laurent S, Boutouyrie P. Arterial stiffness and hypertension in the elderly. Front Cardiovasc Med. 2020;7(202):544302.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003;107(22):2864–9.

    Article  PubMed  Google Scholar 

  30. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, et al. European Resuscitation Council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation. 2010;81(10):1305–52.

    Article  PubMed  Google Scholar 

  31. Kannel WB, Dawber TR, McGee DL. Perspectives on systolic hypertension. The Framingham study. Circulation. 1980;61(6):1179–82.

    Article  CAS  PubMed  Google Scholar 

  32. Himmelmann A, Hedner T, Hansson L, O’Donnell CJ, Levy D. Isolated systolic hypertension: an important cardiovascular risk factor. Blood Press. 1998;7(4):197–207.

    Article  CAS  PubMed  Google Scholar 

  33. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet. 1997;350(9080):757–64.

    Article  CAS  PubMed  Google Scholar 

  34. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991;265(24):3255–64.

    Google Scholar 

  35. Tanner RM, Shimbo D, Seals SR, Reynolds K, Bowling CB, Ogedegbe G, et al. White-coat effect among older adults: data from the Jackson heart study. J Clin Hypertens (Greenwich). 2016;18(2):139–45.

    Article  Google Scholar 

  36. Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control. 2018;11:73–9.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Williams B, Mancia G, Spiering W. ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;2018:39.

    Google Scholar 

  38. Helvaci MR, Seyhanli M. What a high prevalence of white coat hypertension in society! Intern Med. 2006;45(10):671–4.

    Article  PubMed  Google Scholar 

  39. Reddy AK, Jogendra MR, Rosendorff C. Blood pressure measurement in the geriatric population. Blood Press Monit. 2014;19(2):59–63.

    Article  PubMed  Google Scholar 

  40. de Simone G, Schillaci G, Chinali M, Angeli F, Reboldi GP, Verdecchia P. Estimate of white-coat effect and arterial stiffness. J Hypertens. 2007;25(4):827–31.

    Article  PubMed  CAS  Google Scholar 

  41. Cai P, Peng Y, Wang Y, Wang X. Effect of white-coat hypertension on arterial stiffness: a meta-analysis. Medicine. 2018;97(42):e12888.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kario K, Tomitani N, Buranakitjaroen P, Chia YC, Park S, Chen CH, et al. Home blood pressure control status in 2017-2018 for hypertension specialist centers in Asia: results of the Asia BP@Home study. J Clin Hypertens. 2018;20(12):1686–95.

    Article  Google Scholar 

  43. Cacciolati C, Hanon O, Alpérovitch A, Dufouil C, Tzourio C. Masked hypertension in the elderly: cross-sectional analysis of a population-based sample. Am J Hypertens. 2011;24(6):674–80.

    Article  PubMed  Google Scholar 

  44. Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens. 2007;25(11):2193–8.

    Article  CAS  PubMed  Google Scholar 

  45. Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. Am J Hypertens. 2011;24(1):52–8.

    Article  PubMed  Google Scholar 

  46. Mallion J-M, Clerson P, Bobrie G, Genes N, Vaisse B, Chatellier G. Predictive factors for masked hypertension within a population of controlled hypertensives. J Hypertens. 2006;24(12):2365–70.

    Article  CAS  PubMed  Google Scholar 

  47. Gorostidi M, Vinyoles E, Banegas JR, de la Sierra A. Prevalence of white-coat and masked hypertension in national and international registries. Hypertens Res. 2015;38(1):1–7.

    Article  PubMed  Google Scholar 

  48. Obara T, Ohkubo T, Funahashi J, Kikuya M, Asayama K, Metoki H, et al. Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study. J Hypertens. 2005;23(9):1653–60.

    Article  CAS  PubMed  Google Scholar 

  49. Parashar R, Amir M, Pakhare A, Rathi P, Chaudhary L. Age related changes in autonomic functions. J Clin Diagn Res. 2016;10(3):CC11–C5.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Baker SE, Limberg JK, Dillon GA, Curry TB, Joyner MJ, Nicholson WT. Aging alters the relative contributions of the sympathetic and parasympathetic nervous system to blood pressure control in women. Hypertension. 2018;72(5):1236–42.

    Article  CAS  PubMed  Google Scholar 

  51. Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med. 2007;120(10):841–7.

    Article  PubMed  Google Scholar 

  52. Brignole M. Progressive orthostatic hypotension in the elderly. e-journal of the ESC Council for Cardiology Practice 2006;5(10). https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-5/Progressive-orthostatic-hypotension-in-the-elderly-Title-Progressive-orthosta. Accessed 9 Aug 2021.

  53. Saedon NI, Pin Tan M, Frith J. The prevalence of orthostatic hypotension: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2020;75(1):117–22.

    Article  PubMed  Google Scholar 

  54. Grassi G, Mark A, Esler M. The sympathetic nervous system alterations in human hypertension. Circ Res. 2015;116(6):976–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Esler M. The sympathetic nervous system in hypertension: back to the future? Curr Hypertens Rep. 2015;17(2):11.

    Article  PubMed  CAS  Google Scholar 

  56. Catheter-based renal sympathetic denervation for resistant hypertension: Durability of blood pressure reduction out to 24 months. Hypertension 2011;57(5):911–7.

    Google Scholar 

  57. Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376(9756):1903–9.

    Article  PubMed  Google Scholar 

  58. Courand PY, Feugier P, Workineh S, Harbaoui B, Bricca G, Lantelme P. Baroreceptor stimulation for resistant hypertension: first implantation in France and literature review. Arch Cardiovasc Dis. 2014;107(12):690–6.

    Article  PubMed  Google Scholar 

  59. Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370(15):1393–401.

    Article  CAS  PubMed  Google Scholar 

  60. Cuspidi C, Sala C, Negri F, Mancia G, Morganti A. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26(6):343–9.

    Article  CAS  PubMed  Google Scholar 

  61. Ching S, Chia Y, Azman WW. Prevalence and determinants of left ventricular hypertrophy in hypertensive patients at a primary care clinic. Malays Fam Physician. 2012;7(2–3):2.

    PubMed  PubMed Central  Google Scholar 

  62. Krumholz HM, Larson M, Levy D. Sex differences in cardiac adaptation to isolated systolic hypertension. Am J Cardiol. 1993;72(3):310–3.

    Article  CAS  PubMed  Google Scholar 

  63. Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. New insights into the relationship of left ventricular geometry and left ventricular mass with cardiac function: a population study of hypertensive subjects. Eur Heart J. 2010;31(5):588–94.

    Article  PubMed  Google Scholar 

  64. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19(7):1550–8.

    Article  CAS  PubMed  Google Scholar 

  65. Devereux RB, James GD, Pickering TG. What is normal blood pressure? Comparison of ambulatory pressure level and variability in patients with normal or abnormal left ventricular geometry. Am J Hypertens. 1993;6(6 Pt 2):211s–5s.

    CAS  PubMed  Google Scholar 

  66. Sweitzer NK, Lopatin M, Yancy CW, Mills RM, Stevenson LW. Comparison of clinical features and outcomes of patients hospitalized with heart failure and normal ejection fraction (> or =55%) versus those with mildly reduced (40% to 55%) and moderately to severely reduced (<40%) fractions. Am J Cardiol. 2008;101(8):1151–6.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Goldberg RJ, Spencer FA, Farmer C, Meyer TE, Pezzella S. Incidence and hospital death rates associated with heart failure: a community-wide perspective. Am J Med. 2005;118(7):728–34.

    Article  PubMed  Google Scholar 

  68. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics 2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–596.

    Article  PubMed  Google Scholar 

  69. Butrous H, Hummel SL. Heart failure in older adults. Can J Cardiol. 2016;32(9):1140–7.

    Article  PubMed  Google Scholar 

  70. Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27(22):2725–36.

    Article  PubMed  Google Scholar 

  71. Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296(18):2217–26.

    Article  CAS  PubMed  Google Scholar 

  72. Oh GC, Cho H-J. Blood pressure and heart failure. Clin Hypertens. 2020;26(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Choi DJ, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, et al. Characteristics, outcomes and predictors of long-term mortality for patients hospitalized for acute heart failure: a report from the Korean Heart Failure Registry. Korean Circ J. 2011;41(7):363–71.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Lee SE, Lee HY, Cho HJ, Choe WS, Kim H, Choi JO, et al. Clinical characteristics and outcome of acute heart failure in Korea: results from the Korean Acute Heart Failure Registry (KorAHF). Korean Circ J. 2017;47(3):341–53.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269–76.

    Article  PubMed  Google Scholar 

  76. Murad K, Goff DC Jr, Morgan TM, Burke GL, Bartz TM, Kizer JR, et al. Burden of comorbidities and functional and cognitive impairments in elderly patients at the initial diagnosis of heart failure and their impact on total mortality: the cardiovascular health study. JACC Heart Fail. 2015;3(7):542–50.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Marengoni A, Tazzeo C, Calderón-Larrañaga A, Roso-Llorach A, Onder G, Zucchelli A, et al. Multimorbidity patterns and 6-year risk of institutionalization in older persons: the role of social formal and informal care. J Am Med Dir Assoc. 2021;22:2184.

    Article  PubMed  Google Scholar 

  78. Karamichalakis N, Letsas KP, Vlachos K, Georgopoulos S, Bakalakos A, Efremidis M, et al. Managing atrial fibrillation in the very elderly patient: challenges and solutions. Vasc Health Risk Manag. 2015;11:555–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  79. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5.

    Article  CAS  PubMed  Google Scholar 

  80. Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34(35):2746–51.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation. Circulation. 2014;129(8):837–47.

    Article  PubMed  Google Scholar 

  82. Kistler PM, Sanders P, Fynn SP, Stevenson IH, Spence SJ, Vohra JK, et al. Electrophysiologic and electroanatomic changes in the human atrium associated with age. J Am Coll Cardiol. 2004;44(1):109–16.

    Article  PubMed  Google Scholar 

  83. Nabauer M, Gerth A, Limbourg T, Schneider S, Oeff M, Kirchhof P, et al. The Registry of the German competence NETwork on atrial fibrillation: patient characteristics and initial management. Europace. 2009;11(4):423–34.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Verdecchia P, Angeli F, Reboldi G. Hypertension and atrial fibrillation. Circ Res. 2018;122(2):352–68.

    Article  CAS  PubMed  Google Scholar 

  85. Dominiczak A, Delles C, Padmanabhan S. Genomics and precision medicine for clinicians and scientists in hypertension. Hypertension. 2017;69(4):e10–e3.

    Article  CAS  PubMed  Google Scholar 

  86. Kato N, Loh M, Takeuchi F, Verweij N, Wang X, Zhang W, et al. Trans-ancestry genome-wide association study identifies 12 genetic loci influencing blood pressure and implicates a role for DNA methylation. Nat Genet. 2015;47(11):1282–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Mattson DL, Liang M. Hypertension: from GWAS to functional genomics-based precision medicine. Nat Rev Nephrol. 2017;13(4):195–6.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288–98.

    Article  PubMed  Google Scholar 

  89. Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin N Am. 2004;33(2):351–75.

    Article  Google Scholar 

  90. Ramachandran A, Chamukuttan S, Shetty SA, Arun N, Susairaj P. Obesity in Asia – is it different from rest of the world. Diabetes Metab Res Rev. 2012;28(s2):47–51.

    Article  PubMed  Google Scholar 

  91. McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991;337(8738):382–6.

    Article  CAS  PubMed  Google Scholar 

  92. Larsson SC, Bäck M, Rees JMB, Mason AM, Burgess S. Body mass index and body composition in relation to 14 cardiovascular conditions in UK Biobank: a Mendelian randomization study. Eur Heart J. 2020;41(2):221–6.

    Article  CAS  PubMed  Google Scholar 

  93. Zamboni M, Mazzali G. Obesity in the elderly: an emerging health issue. Int J Obes. 2012;36(9):1151–2.

    Article  CAS  Google Scholar 

  94. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491–7.

    Article  PubMed  Google Scholar 

  95. Ariaratnam S, Rodzlan Hasani WS, Krishnapillai AD, Abd Hamid HA, Jane Ling MY, Ho BK, et al. Prevalence of obesity and its associated risk factors among the elderly in Malaysia: findings from The National Health and Morbidity Survey (NHMS) 2015. PLoS One. 2020;15(9):e0238566.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  96. Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014;371(7):624–34.

    Article  PubMed  Google Scholar 

  97. WHO. Fact sheet on salt reduction. WHO Publication. 2020. https://www.who.int/news-room/fact-sheets/detail/salt-reduction. Accessed 9 Aug 2021.

  98. INTERSALT study an international co-operative study on the relation of blood pressure to electrolyte excretion in populations. I. Design and methods. The INTERSALT Co-operative Research Group. J Hypertens. 1986;4(6):781–7.

    Google Scholar 

  99. Dahl. Possible role of salt intake in the development of essential hypertension. In: Cottier P, Bock D, editors. Essential hypertension: an international symposium. Berlin: Springer; 1960. p. 52–65.

    Google Scholar 

  100. Stamler J. The INTERSALT Study: background, methods, findings, and implications. Am J Clin Nutr. 1997;65(2 Suppl):626s–42s.

    Article  CAS  PubMed  Google Scholar 

  101. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ. 1988;297(6644):319–28.

    Google Scholar 

  102. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med. 2001;344(1):3–10.

    Article  CAS  PubMed  Google Scholar 

  103. Zhou BF, Stamler J, Dennis B, Moag-Stahlberg A, Okuda N, Robertson C, et al. Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTERMAP study. J Hum Hypertens. 2003;17(9):623–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Katsuya T, Ishikawa K, Sugimoto K, Rakugi H, Ogihara T. Salt sensitivity of Japanese from the viewpoint of gene polymorphism. Hypertens Res. 2003;26(7):521–5.

    Article  PubMed  Google Scholar 

  105. Obarzanek E, Proschan MA, Vollmer WM, Moore TJ, Sacks FM, Appel LJ, et al. Individual blood pressure responses to changes in salt intake. Hypertension. 2003;42(4):459–67.

    Article  CAS  PubMed  Google Scholar 

  106. Stamler J, Rose G, Stamler R, Elliott P, Dyer A, Marmot M. INTERSALT study findings. Public health and medical care implications. Hypertension. 1989;14(5):570–7.

    Article  CAS  PubMed  Google Scholar 

  107. Higashi Y, Oshima T, Ozono R, Nakano Y, Matsuura H, Kambe M, et al. Nocturnal decline in blood pressure is attenuated by NaCl loading in salt-sensitive patients with essential hypertension: noninvasive 24-hour ambulatory blood pressure monitoring. Hypertension. 1997;30(2 Pt 1):163–7.

    Article  CAS  PubMed  Google Scholar 

  108. Takakuwa H, Shimizu K, Izumiya Y, Kato T, Nakaya I, Yokoyama H, et al. Dietary sodium restriction restores nocturnal reduction of blood pressure in patients with primary aldosteronism. Hypertens Res. 2002;25(5):737–42.

    Article  CAS  PubMed  Google Scholar 

  109. Yatabe MS, Yatabe J, Yoneda M, Watanabe T, Otsuki M, Felder RA, et al. Salt sensitivity is associated with insulin resistance, sympathetic overactivity, and decreased suppression of circulating renin activity in lean patients with essential hypertension. Am J Clin Nutr. 2010;92(1):77–82.

    Article  CAS  PubMed  Google Scholar 

  110. Melander O, Groop L, Hulthén UL. Effect of salt on insulin sensitivity differs according to gender and degree of salt sensitivity. Hypertension. 2000;35(3):827–31.

    Article  CAS  PubMed  Google Scholar 

  111. Ebata H, Hojo Y, Ikeda U, Ishida H, Natsume T, Shimada K. Differential effects of an alpha 1-blocker (doxazosin) on diurnal blood pressure variation in dipper and non-dipper type hypertension. Hypertens Res. 1995;18(2):125–30.

    Article  CAS  PubMed  Google Scholar 

  112. O’Sullivan C, Duggan J, Atkins N, O’Brien E. Twenty-four-hour ambulatory blood pressure in community-dwelling elderly men and women, aged 60-102 years. J Hypertens. 2003;21(9):1641–7.

    Article  PubMed  Google Scholar 

  113. Imai Y, Nagai K, Sakuma M, Sakuma H, Nakatsuka H, Satoh H, et al. Ambulatory blood pressure of adults in Ohasama, Japan. Hypertension. 1993;22(6):900–12.

    Article  CAS  PubMed  Google Scholar 

  114. Uzu T, Ishikawa K, Fujii T, Nakamura S, Inenaga T, Kimura G. Sodium restriction shifts circadian rhythm of blood pressure from nondipper to dipper in essential hypertension. Circulation. 1997;96(6):1859–62.

    Article  CAS  PubMed  Google Scholar 

  115. Uzu T, Kimura G, Yamauchi A, Kanasaki M, Isshiki K, Araki SI. Enhanced sodium sensitivity and disturbed circadian rhythm of blood pressure in essential hypertension. J Hypertens. 2006;24:1627.

    Article  CAS  PubMed  Google Scholar 

  116. He J, Gu D, Chen J, Jaquish CE, Rao DC, Hixson JE, et al. Gender difference in blood pressure responses to dietary sodium intervention in the GenSalt study. J Hypertens. 2009;27(1):48–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  117. Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG, et al. Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med. 2001;135(12):1019–28.

    Article  CAS  PubMed  Google Scholar 

  118. Weinberger MH, Fineberg NS. Sodium and volume sensitivity of blood pressure. Age and pressure change over time. Hypertension. 1991;18(1):67–71.

    Article  CAS  PubMed  Google Scholar 

  119. Elijovich F, Weinberger MH, Anderson CA, Appel LJ, Bursztyn M, Cook NR, et al. Salt sensitivity of blood pressure: a scientific statement from the American Heart Association. Hypertension. 2016;68(3):e7–e46.

    Article  CAS  PubMed  Google Scholar 

  120. Liu Y, Shi M, Dolan J, He J. Sodium sensitivity of blood pressure in Chinese populations. J Hum Hypertens. 2020;34(2):94–107.

    Article  CAS  PubMed  Google Scholar 

  121. Mitsutake SIT, Teramoto C, Shimizu S, Ito H. Patterns of co-occurrence of chronic disease among older adults in Tokyo, Japan. Prev Chronic Dis. 2019;16(180170) https://doi.org/10.5888/pcd16.180170. Accessed 9 Aug 2021.

  122. Jang I-Y, Lee HY, Lee E. Th anniversary Committee of Korean Geriatrics S. geriatrics fact sheet in Korea 2018 from National Statistics. Ann Geriatr Med Res. 2019;23(2):50–3.

    Article  PubMed  PubMed Central  Google Scholar 

  123. Kim H-A, Shin J-Y, Kim M-H, Park B-J. Prevalence and predictors of polypharmacy among Korean elderly. PLoS One. 2014;9(6):e98043.

    Article  PubMed  PubMed Central  Google Scholar 

  124. Mabuchi T, Hosomi K, Yokoyama S, Takada M. Polypharmacy in elderly patients in Japan: analysis of Japanese real-world databases. J Clin Pharm Ther. 2020;45(5):991–6.

    Article  PubMed  Google Scholar 

  125. Morin L, Johnell K, Laroche M-L, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018;10:289–98.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104.

    Article  PubMed  Google Scholar 

  127. Chia Y-C, Turana Y, Sukonthasarn A, Zhang Y, Shin J, Cheng H-M, et al. Comparison of guidelines for the management of hypertension: similarities and differences between international and Asian countries; perspectives from HOPE-Asia Network. J Clin Hypertens. 2021;23(3):422–34.

    Article  Google Scholar 

  128. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334–57.

    Article  CAS  PubMed  Google Scholar 

  129. Whelton PK, Williams B. The 2018 European Society of Cardiology/European Society of Hypertension and 2017 American College of Cardiology/American Heart Association blood pressure guidelines: more similar than DifferentComparison of the 2018 ESC/ESH and 2017 ACC/AHA hypertension GuidelinesComparison of the 2018 ESC/ESH and 2017 ACC/AHA hypertension guidelines. JAMA. 2018;320(17):1749–50.

    Article  PubMed  Google Scholar 

  130. Chia Y. Review of tools of cardiovascular disease risk stratification: interpretation, customisation and application in clinical practice. Singap Med J. 2011;52(2):116–23.

    CAS  Google Scholar 

  131. Bulpitt C, Fletcher A, Beckett N, Coope J, Gil-Extremera B, Forette F, et al. Hypertension in the very elderly trial (HYVET): protocol for the main trial. Drugs Aging. 2001;18(3):151–64.

    Article  CAS  PubMed  Google Scholar 

  132. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887–98.

    Article  CAS  PubMed  Google Scholar 

  133. Liu J. Highlights of the 2018 Chinese hypertension guidelines. Clin Hypertens. 2020;26(1):8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  134. Kim HC, Ihm S-H, Kim G-H, Kim JH, Kim K-i, Lee H-Y, et al. 2018 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology of hypertension. Clin Hyperten. 2019;25(1):16.

    Article  Google Scholar 

  135. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42(9):1235–481.

    Article  PubMed  Google Scholar 

  136. Philippines clinical practice guideline for adult hypertension-prevention, screening, counseling and management. 2018. www.mahealthcare.com/pdf/practice_guidelines.

  137. 2018 Vietnam National Heart Association/Vietnam Society of Hypertension guidelines on diagnosis and treatment of arterial hypertension in adults. 2018 VNHA/VSH guidelines for diagnosis and treatment of hypertension … slideshare.net. Accessed 9 Aug 2021.

  138. 2018 Pakistan Hypertension League 3rd National Guideline for the prevention, detection, evaluation and Managment of hypertension 2018. PHL 2018 Magazine Final 1. phlpk.org. Accessed 9 Aug 2021.

Download references

Author information

Authors and Affiliations

  1. Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Selangor Darul Ehsan, Malaysia

    Yook-Chin Chia

  2. Faculty of Medicine, Department of Primary Care Medicine, University of Malays, Kuala Lumpur, Malaysia

    Yook-Chin Chia

Authors
  1. Yook-Chin Chia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yook-Chin Chia .

Editor information

Editors and Affiliations

  1. Apollo Hospitals, Apollo Institute for Blood Pressure Management, Hyderabad, India

    C. Venkata S. Ram

  2. Head, Division of Nephrology Department of Medicine, Yong Loo Lin Sch of Med Natl Univ of Sin, Singapore, Singapore

    Boon Wee Jimmy Teo

  3. Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College, Ludhiana, Punjab, India

    Gurpreet S. Wander

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chia, YC. (2022). Hypertension in the Elderly: Pathophysiology and Clinical Significance. In: Ram, C.V.S., Teo, B.W.J., Wander, G.S. (eds) Hypertension and Cardiovascular Disease in Asia. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-030-95734-6_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-95734-6_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95733-9

  • Online ISBN: 978-3-030-95734-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation