Age Related Hemodynamic Blood Pressure Changes for Cardiovascular Disease and Stroke: A Mini-review

The blood pressure (BP) changes with the advancement of age from the predominant diastolic BP (DBP) in the young to the predominant systolic BP (SBP) in the older person. This shift is due to the stiffening of the large arteries as a result of the ageing process and the replacement of the elastic fibers with collagen fibers resulting in the loss of compliance and the elastic recoil of these vessels. The end result is augmentation in pulse wave velocity (PWV) and widening of pulse pressure (PP). The SBP rises linearly with the advancement of age whereas, the DBP rises up to the age 50 years and begins to decline after the age of 60 years leading to a progressive increase in PP. These hemodynamic changes of BP are frequently associated with an increased incidence in cardiovascular disease (CVD) and strokes. Several studies have shown an inverse relationship between DBP and CVD, whereas no such a relationship has been demonstrated for stroke. However, recently, an inverse relationship has been reported between DBP and stroke for subjects 50 years of age or older. The implications of BP changes with age as they are related to CVD and strokes will be discussed in this mini review. It appears from these recent findings that in treating the hypertension in the elderly to reduce CVD and stroke, care should be taken not to allow the DBP to drop below 55-80 mmHg, since below this DBP level the incidence of CVD and strokes increase.