Hypertension in the elderly

Arterijska hipertenzija (AH) u starijih osoba predstavlja veliki javnozdravstveni problem zbog visoke prevalencije i trenda starenja svjetske populacije. Najčešće se radi o izoliranoj sistoličkoj hipertenziji (90% bolesnika iznad 70 godina) te se kod osoba starije životne dobi kao najbitniji čimbenici rizika izdvajaju vrijednosti tlaka pulsa i sistoličkog tlaka. Patofiziološki u podlozi su brojne strukturne (gubitak elastičnosti velikih krvnih žila, smanjena rastezljivost, porast brzine pulsnog vala) i funkcionalne (endotelna disfunkcija, smanjena osjetljivost beta receptora, smanjena funkcija baroreceptora, osjetljivost na sol) promjene. Liječenje AH u starijih do sada je bilo veliki izazov jer nije bilo dovoljno studija koje su se bavile tom populacijom, što se promijenilo objavom rezultata studije HYVET. Ova je studija uključila najstarije bolesnike (iznad 80 godina) te je dokazala kako sniženje vrijednosti arterijskog tlaka za 15/6 mmHg dovodi do značajno manje opće smrtnosti (21%), kardiovaskularne smrtnosti (23%), incidencije moždanog udara (30%) i srčanog zatajivanja (64%). Kao lijek prvog izbora u starijoj populaciji izdvojili bismo tijazidski diuretik, a budući ti pacijenti većinom zahtijevaju višestruku terapiju izdvojili bismo blokatore kalcijskih kanala ili ACE inhibitore. Naravno i komorbiditeti određuju osnovnu ili dodatnu terapiju.Hypertension in the elderly is a major public health problem due to high prevalence and the world population ageing trend. Most often it is the isolated systolic hypertension (90% of patients over 70 years of age) that is concerned. Furthermore, pulse pressure and systolic pressure are the most important risk factors in elderly persons. Pathophysiologically, there is a great number of structural (loss of elasticity of large blood vessels, decreased elasticity, increased pulse wave velocity) and functional (endothelial dysfunction, decreased sensitivity of beta receptors, decreased baroreceptor function, sensitivity to salt) changes in the background. Treatment of hypertension in the elderly has so far been a big challenge, because there were not enough studies that have dealt with this population. Now this has changed after results of the HYVET study have been published. HYVET study included the oldest patients (above 80 years of age) and has proven that lowering pressure by 15/6 mmHg, leads to significantly lower overall mortality (21%), cardiovascular mortality (23%), incidence of stroke (30%) and heart failure (64%). We emphasize thiazide diuretic as the first choice drug in the elderly population, and since these patients usually require multiple treatment, we emphasize calcium channel blockers or ACE inhibitors. Comorbidities, naturally, determine the basic or additional therapy