Hypertension and aging

Abstract

Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms--including inflammation, oxidative stress, and endothelial dysfunction--are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension.

Keywords: Antihypertensive; Blood pressure; Cardiovascular; Cognition; Disability; Falls.

Figure 1

Prevalence of hypertension among adults by age and sex according to the National Health and Nutrition Examination Survey: 2007-2012. Re-created from Chart 9.1 in Mozaffarian et al.(Mozaffarian et al., 2015)

Figure 2

Simplified schematic illustrating common relationships of aging and hypertension with inflammation, oxidative stress, and vascular dysfunction – i.e. Vascular Health Triad. Modified from Figure 2 in Wadley et al.(Wadley et al., 2013) (Figure 2) and Figure 1 in Dinh et al.(Dinh et al., 2014)

Figure 3

Simplified schematic of the multi-dimensional health risks for older adults with hypertension. Note the dashed arrows indicating the inter-related nature of health outcomes whereby the presence of one condition tends to increase risk of one or more of the others.

Figure 4

Risks of cognitive decline and development of mild cognitive impairment (MCI)/dementia among hypertensive older adults. Panel A): Change in objective measures of cognition over 20 years among pre-hypertensive and hypertensive persons aged 48-67 years at baseline. Created from data in Table 2 of Gottesman et al.(Gottesman et al., 2014) (N = 13, 476) and indicate z-score changes relative to normotensive individuals. A z-score change of 0 indicates similar changes to normotensive individuals. Panel B): Risk of developing MCI or dementia over a mean follow-up of 9.1 years among 6,426 women aged 65-79 years. Created from data in Table 1 of Haring et al.(Haring et al., 2015). Hazard ratio (HR) indicates risk of experiencing MCI/dementia compared to normotensive individuals where each 0.1 increase in HR indicates a 10% increase in risk.

Figure 5

Risk of developing physical disability among older adults according to hypertension status, i.e. normotensive, controlled hypertension, or uncontrolled hypertension. Created from data in Table 3 of Hajjar et al.(Hajjar et al., 2007) Data reflect rates of disability based on three validated disability scales: the Nagi Scale, Rosow-Breslaw Scale, and Katz Activities of Daily Living (ADL) Scale.

Figure 6

Conceptual figure illustrating the potential points of intervention for the multi-dimensional risks of hypertension among older adults. Inner rings indicate the potential health risks of late-life hypertension; middle ring indicates mechanistic risk factors exacerbated by hypertension (bold) and potential interventions to combat these risks (non-bold); outer ring indicates concomitant risk factors which contribute to both hypertension and associated health outcomes (bold) as well as potential interventions to combat these risks (non-bold).