Hemodynamic changes in elderly hypertensive patients.

Hypertension in the elderly is characterized by a disproportionate increase of systolic blood pressure over diastolic blood pressure. Subsequently, in this category of patients, the increase in pulse pressure predominates over the increase in mean arterial pressure, thus highlighting the role of arterial changes in this pattern of hemodynamics. In the presence of normal or reduced cardiac function, the disproportionate increase in systolic pressure is the result of a combination of increases of both arterial stiffness and wave reflections. The former is primarily due to central aortic structural changes with a small contribution by modifications of the smooth muscle tone of the central large arteries. The latter is secondary to the geometric modifications of the arterial system associated with age that are responsible for the increase in wave reflections within the thoracic aorta as a consequence of increases in pulse wave velocity and in reflection points closer to the heart.