Geriatric cardiology. Hypertension as a risk factor in elderly patients
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Abstract
High arterial pressure (AP), along with age, is the most significant risk factor for cardiovascular (CV) diseases, general and CV mortality in the late ontogenesis. The age-related decrease in relative risk of elevated AP against the absolute risk growth is determined by the prevalence of hypertensive individuals in the gerontological population. The prognostic ambivalence of AP pressure in old age is due to the significance of not only elevated but also low AP, including orthostatic hypotension. The global importance of arterial hypertension in old age is determined by its causal role in the development of not only CVD, but also other age-associated pathologies, in particular, neurodegenerative diseases (cognitive decline and dementia, Parkinson’s disease), physical and psychoemotional geriatric syndromes, as well as the most frequent component of multimorbid patterns. Antihypertensive therapy in the elderly is the most effective tool not only for the prevention of CV diseases, premature death, but also associated with slowing down the rate of cognitive decline, changing the trajectory of frailty. At the same time, the oldest age and the complex clinical profile of patients with geriatric syndromes invert the significance of elevated AP as a risk factor. Currently, there is a lack of evidence base regarding the effect on the effectiveness/safety of antihypertensive therapy not only for old age per se, but especially of the oldest, not only for multimorbidity per se, but of its certain patterns, the presence of the most common and socially significant geriatric syndromes and poor functional status.
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