Giannattasio C, Ferrari A U, Mancia G
Cattedra di Medicina Interna I, Ospedale S. Gerardo dei Tintori, Monza, Milan, Italy.
J Hypertens Suppl. 1994 Sep;12(6):S13-7.
Ageing is associated with functional and structural alterations to the cardiovascular system. Evidence is accumulating, however, that ageing also determines major changes in the effectiveness of mechanisms involved in blood pressure control and that this represents an important determinant of the cardiovascular changes that can be observed in the elderly. DIFFERENCES SEEN IN ELDERLY SUBJECTS: It has been observed that compared to young subjects, in the elderly (1) baroreceptor control of the heart rate and cardiac function is impaired; (2) baroreceptor modulation of the sympathetic drive to the peripheral circulation is impaired, particularly the speed of reflex adjustments to normal and abnormal stimuli; and (3) cardiopulmonary stretch receptors, which tonically inhibit sympathetic tone, the renal release of renin and vasopressin secretion, are impaired. These three factors may account, at least in part, for the raised blood pressure and sympathetic activity in the elderly. They certainly explain the reduced ability of elderly people to maintain blood pressure and blood volume homeostasis, and their increased blood pressure variability over 24 h. ASSOCIATION WITH HYPERTENSION: All these problems are exacerbated if ageing is associated with hypertension, and are highly relevant to antihypertensive treatment. Care should be taken that any antihypertensive drugs selected for treatment in the elderly do not aggravate these basic homeostatic problems.
衰老与心血管系统的功能和结构改变相关。然而，越来越多的证据表明，衰老还决定了参与血压控制的机制在有效性方面的重大变化，并且这是老年人中可观察到的心血管变化的一个重要决定因素。
据观察，与年轻受试者相比，老年人存在以下情况：（1）压力感受器对心率和心脏功能的控制受损；（2）压力感受器对外周循环交感神经驱动的调节受损，尤其是对正常和异常刺激的反射调节速度；（3）心肺牵张感受器功能受损，该感受器可紧张性抑制交感神经张力、肾素的肾脏释放和血管加压素分泌。这三个因素可能至少部分解释了老年人血压升高和交感神经活动增强的原因。它们肯定解释了老年人维持血压和血容量稳态的能力下降，以及他们24小时内血压变异性增加的现象。
如果衰老与高血压相关，所有这些问题都会加剧，并且与抗高血压治疗高度相关。在为老年人选择治疗用的任何抗高血压药物时应小心，以免加重这些基本的稳态问题。
