CHAPTER


DOI :10.26650/B/CH12CH47.2023.014.16   IUP :10.26650/B/CH12CH47.2023.014.16    Full Text (PDF)

Yaşlı Hi̇pertansi̇flerde Özel Sorunlar

Bülent KayaNeslihan Seyrekİbrahim Karayaylalı

Hipertansiyon yaşlılarda sık görülen bir hastalıktır ve olumsuz sonuçlara neden olur. Hipertansiyon etyolojisinde rol oynayan renal sodyum retansiyonu yaşlılarda gençlere göre daha fazladır. Ayrıca artan yaş ile birlikte arteriyel sertlik artar bu nedenle yaşlılarda sistolik basınç yüksek, diastolik basınç düşük bulunur ve bu nedenle nabız basıncı artmış saptanır. En fazla yaşlı hastalarda saptanan psödohipertansiyon osler manevrasının pozitif olması ile tespit edilebilir.Yaşlılarda ayrıca ortostatik hipotansiyon da sık görülür ve bu durum düşme ve kırıklarla ilişkilidir. Ayrıca parkinson ve diyabet gibi otonom disfonksiyonu olan yaşlı bireylerde postprandiyal hipotansiyon, postprandiyal hipertansiyon da görülebilir. Dolayısıyla yaşlılarda antihipertansif tedavi planlanırken tüm bu durumlar göz önünde bulundurulmalıdır. Bu bölümde yaşlı hipertansif bireylerdeki özel sorunlardan bahsedilecektir.



References

  • 1. Luft FC, Miller JZ, Grim CE, Fineberg NS, Christian JC, Daugherty SA, Weinberger MH. Salt sensitivity and resistance of blood pressure. Age and race as factors in physiological responses. Hypertension. 1991 Jan;17(1 Suppl):I102-8. google scholar
  • 2. Frame AA, Wainford RD. Mechanisms of altered renal sodium handling in age-related hypertension. Am J Physiol Renal Physiol. 2018 Jul 1;315(1):F1-F6. google scholar
  • 3. Vatner SF, Zhang J, Vyzas C, Mishra K, Graham RM, Vatner DE. Vascular Stiffness in Aging and Disease. Front Physiol. 2021 Dec 7;12:762437. google scholar
  • 4. Chaudhry R, Miao JH, Rehman A. Physiology, Cardiovascular. [Updated 2022 Oct 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm. nih.gov/books/NBK493197/ google scholar
  • 5. Sun Z. Aging, arterial stiffness, and hypertension. Hypertension. 2015 Feb;65(2):252-6. google scholar
  • 6. Laurent S, Boutouyrie P. Arterial Stiffness and Hypertension in the Elderly. Front Cardiovasc Med. 2020 Oct 29;7:544302. google scholar
  • 7. Nichols, W. W., M. F. O’Rourke, and W. Larry Kenney. “McDonald’s Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles, ed. 3.” (1991): 407. google scholar
  • 8. Latham RD, Westerhof N, Sipkema P, Rubal BJ, Reuderink P, Murgo JP. Regional wave travel and reflec-tions along the human aorta: a study with six simultaneous micromanometric pressures. Circulation. 1985 Dec;72(6):1257-69. google scholar
  • 9. Franklin SS, Wong ND. Pulse Pressure: How Valuable as a Diagnostic and Therapeutic Tool? google scholar
  • 10. J Am Coll Cardiol. 2016 Feb 2;67(4):404-406. google scholar
  • 11. Franklin SS, Jacobs MJ, Wong ND, L’Italien GJ, Lapuerta P. Predominance of isolated systolic hyperten-sion among middle-aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension. 2001 Mar;37(3):869-74. google scholar
  • 12. Safar ME. Systolic blood pressure, pulse pressure and arterial stiffness as cardiovascular risk factors. Curr Opin Nephrol Hypertens. 2001 Mar;10(2):257-61. google scholar
  • 13. Patil MM, Kamalanathan S, Sahoo JP, Vivekanandan M. Pseudo hypertension: Clue from Osler sign. J Family Med Prim Care. 2016 Jul-Sep;5(3):743. google scholar
  • 14. Messerli FH, Ventura HO, Amodeo C. Osler’s maneuver and pseudohypertension. N Engl J Med. 1985 Jun 13;312(24):1548-51. google scholar
  • 15. Spence JD. Pseudo-hypertension in the elderly: still hazy, after all these years. J Hum Hypertens. 1997 Oct;11(10):621-3. google scholar
  • 16. Franklin SS, Wilkinson IB, McEniery CM. Unusual hypertensive phenotypes: what is their significance? Hypertension. 2012 Feb;59(2):173-8. google scholar
  • 17. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, Cheshire WP, Chelimsky T, Cortelli P, Gibbons CH, Goldstein DS, Hainsworth R, Hilz MJ, Jacob G, Kaufmann H, Jordan J, Lipsitz LA, Levine BD, Low PA, Mathias C, Raj SR, Robertson D, Sandroni P, Schatz I, Schondorff R, Stewart JM, van Dijk JG. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011 Apr;21(2):69-72 google scholar
  • 18. Magkas N, Tsioufis C, Thomopoulos C, Dilaveris P, Georgiopoulos G, Sanidas E, Papademetriou V, Tou-soulis D. Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic conside-rations. J Clin Hypertens (Greenwich). 2019 May;21(5):546-554. google scholar
  • 19. Hollister AS. Orthostatic hypotension. Causes, evaluation, and management. West J Med. 1992;157(6):652-657. google scholar
  • 20. Wieling W, Kaufmann H, Claydon VE, van Wijnen VK, Harms MPM, Juraschek SP, Thijs RD. Diagnosis and treatment of orthostatic hypotension. Lancet Neurol. 2022 Aug;21(8):735-746. google scholar
  • 21. Verwoert GC, Mattace-Raso FU, Hofman A, Heeringa J, Stricker BH, Breteler MM, Witteman JC. Orthos-tatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc. 2008 Oct;56(10):1816-20. google scholar
  • 22. Jodaitis L, Vaillant F, Snacken M, Boland B, Spinewine A, Dalleur O, Gilles C, Petrovic M, Pepersa-ck T. Orthostatic hypotension and associated conditions in geriatric inpatients. Acta Clin Belg. 2015 Aug;70(4):251-8. google scholar
  • 23. Benvenuto LJ, Krakoff LR. Morbidity and mortality of orthostatic hypotension: implications for manage-ment of cardiovascular disease. Am J Hypertens. 2011 Feb;24(2):135-44. google scholar
  • 24. Angelousi A, Girerd N, Benetos A, Frimat L, Gautier S, Weryha G, Boivin JM. Association between ort-hostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis. J Hypertens. 2014 Aug;32(8):1562-71; discussion 1571. google scholar
  • 25. Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician. 2011 Sep 1;84(5):527-36. google scholar
  • 26. Blank SG, West JE, Muller FB, Pecker MS, Laragh JH, Pickering TG. Characterization of auscultatory gaps with wideband external pulse recording. Hypertension. 1991;17:225-33. google scholar
  • 27. Fessel J, Robertson D. Orthostatic hypertension: when pressor reflexes overcompensate. Nat Clin Pract Nephrol. 2006 Aug;2(8):424-31. google scholar
  • 28. Kario K. Orthostatic hypertension-a new haemodynamic cardiovascular risk factor. Nat Rev Nephrol. 2013 Dec;9(12):726-38 google scholar
  • 29. Hirai FE, Moss SE, Klein BE, Klein R. Postural blood pressure changes and associated factors in long-term Type 1 diabetes: Wisconsin Epidemiologic Study of Diabetic Retinopathy. J Diabetes Complications. 2009 Mar-Apr;23(2):83-8. google scholar
  • 30. Yatsuya, H. et al. Postural changes in blood pressure and incidence of ischemic stroke subtypes: the ARIC study. Hypertension 57, 167-173 (2011). google scholar
  • 31. Pfeiffer RF. Autonomic Dysfunction in Parkinson’s Disease. Neurotherapeutics. 2020 Oct;17(4):1464-1479. google scholar
  • 32. Shibao C, Gamboa A, Diedrich A, Biaggioni I. Management of hypertension in the setting of autonomic dysfunction. Curr Treat Options Cardiovasc Med. 2006 Apr;8(2):105-9. google scholar
  • 33. Kim JS, Lee SH, Oh YS, Park JW, An JY, Choi HS, Lee KS. Arterial Stiffness and Cardiovascular Auto-nomic Dysfunction in Patients with Parkinson’s Disease. Neurodegener Dis. 2017;17(2-3):89-96. google scholar
  • 34. Uetani E, Tabara Y, Igase M, Guo H, Kido T, Ochi N, Takita R, Kohara K, Miki T. Postprandial hyperten-sion, an overlooked risk marker for arteriosclerosis. Atherosclerosis. 2012 Oct;224(2):500-5. google scholar
  • 35. Nguyen TA, Abdelhamid YA, Phillips LK, Chapple LS, Horowitz M, Jones KL, Deane AM. Nutrient stimulation of mesenteric blood flow - implications for older critically ill patients. World J Crit Care Med. 2017 Feb 4;6(1):28-36. google scholar


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