title: Treating blood pressure to prevent strokes: The age factor.
abstract: The importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), on the incidence of coronary heart disease (CHD) and stroke are known. However, the importance of blood pressure (BP)-age shifts regarding the stroke incidence is not clearly known. The BP changes with the advancement of age from the predominance of DBP in the young to the predominance of SBP in the old. This change is due to the stiffening of the large arteries as a result of the aging process and the replacement of the elastic fibers with collagen fibers. This change results in the loss of compliance and the elastic recoil of these vessels leading to increase in pulse wave velocity, central SBP and widening of pulse pressure leading to an increased incidence of CHD and strokes. It has been demonstrated epidemiologically that the SBP rises linearly with age, whereas the DBP rises up to the age of 45-50 years, and then begins to decline after the age of 60 years leading to a progressive widening of PP. Several studies have shown an inverse relationship between DBP and CHD, whereas no such relationship has been demonstrated for stroke. However, a recent study showed an inverse relationship with DBP and stroke when it dropped below 71 mmHg in subjects 50 years of age or older. In contrast, there was a positive association between BP and stroke when both SBP and DBP were ≥ 71 mmHg. These findings suggest that in treating systolic hypertension in the elderly to reduce stroke risk, attention should be paid on the potential harm of low DBP and the widening of PP regarding CHD and stroke. The implications of BP shifts with age and the potential risks of low DBP regarding the risk of stroke will be discussed in this concise review.
authors.affiliation: Steven G Chrysant, Department of Cardiology, University of Oklahoma College of Medicine, Oklahoma City, OK 73102, United States.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Chrysant
keywords: Age; Age blood pressure interaction; Blood pressure; Pulse pressure; Stroke
references.citation: J Cardiovasc Pharmacol. 1990;15 Suppl 1:S38-42
references.pmid: 1695301
references.citation: Am J Cardiol. 2010 Sep 15;106(6):825-9
references.pmid: 20816123
references.citation: J Hum Hypertens. 2004 Dec;18 Suppl 2:S3-7
references.pmid: 15592571
references.citation: J Hypertens. 2009 Nov;27(11):2121-58
references.pmid: 19838131
references.citation: Hypertension. 2003 Dec;42(6):1206-52
references.pmid: 14656957
references.citation: Am J Cardiol. 2004 Aug 1;94(3):380-4
references.pmid: 15276113
references.citation: Arch Intern Med. 2000 Apr 24;160(8):1085-9
references.pmid: 10789600
references.citation: Hypertension. 2001 Aug;38(2):232-7
references.pmid: 11509482
references.citation: Circulation. 2002 Oct 1;106(14):1814-20
references.pmid: 12356635
references.citation: Hypertension. 2007 Jul;50(1):197-203
references.pmid: 17485598
references.citation: Drugs Today (Barc). 2012 May;48(5):353-66
references.pmid: 22645723
references.citation: N Engl J Med. 2010 Apr 29;362(17):1575-85
references.pmid: 20228401
references.citation: Hypertension. 2004 Nov;44(5):715-20
references.pmid: 15452026
references.citation: Hypertension. 2001 Feb;37(2 Pt 2):381-5
references.pmid: 11230304
references.citation: Circulation. 2006 Mar 7;113(9):1213-25
references.pmid: 16476843
references.citation: Am J Cardiol. 1971 Apr;27(4):335-46
references.pmid: 5572576
references.citation: Hypertension. 2012 Dec;60(6):1393-9
references.pmid: 23108660
references.citation: Arch Intern Med. 2001 May 14;161(9):1183-92
references.pmid: 11343441
references.citation: Kidney Int. 2013 Jan;83(1):167-76
references.pmid: 23051740
references.citation: Ann Intern Med. 2006 Jun 20;144(12):884-93
references.pmid: 16785477
references.citation: Hypertension. 1995 Jul;26(1):2-9
references.pmid: 7607724
references.citation: Circulation. 2001 Mar 6;103(9):1245-9
references.pmid: 11238268
references.citation: Arch Intern Med. 1993 Jan 25;153(2):154-83
references.pmid: 8422206
references.citation: Hypertension. 2012 Nov;60(5):1117-23
references.pmid: 23006731
references.citation: Arch Intern Med. 2007 Sep 24;167(17):1884-91
references.pmid: 17893310
references.citation: Circulation. 2010 Nov 23;122(21):2142-51
references.pmid: 21060068
references.citation: J Hypertens. 2009 Jul;27(7):1360-9
references.pmid: 19506526
references.citation: J Hypertens. 2007 Sep;25(9):1751-62
references.pmid: 17762635
references.citation: Lancet. 2008 Jun 28;371(9631):2219-21
references.pmid: 18561995
references.citation: J Clin Hypertens (Greenwich). 2007 Aug;9(8):601-7
references.pmid: 17673881
references.citation: Hypertension. 2000 Nov;36(5):801-7
references.pmid: 11082146
references.citation: Hypertension. 2010 Mar;55(3):698-705
references.pmid: 20083726