Aging and Hypertension: Hemodynamic Implications of Systolic Pressure Trends

The progressive rise in systolic pressure throughout life is accepted as a phenomenon of “normative aging,” although elevated systolic pressure is established as an independent risk factor for untoward cardiovascular events. An analysis of published data for many thousands of individuals indicates comparable average systolic pressure increments of approximately 20 mm Hg between the ages of 40 and 65 years for both normotensives and hypertensives. In both groups there is a disproportionate rise in systolic pressure, that is, systolic increases more than mean and diastolic pressures. In a young person with a normally elastic arterial system an increase in total peripheral resistance (TPR) produces the same increments in systolic, diastolic, and mean arterial pressures; a decrease in arterial distensibility (AD), on the other hand, increases systolic pressure and decreases diastolic pressure to the same extent, leaving mean pressure unchanged. Thus, the proportion of the systolic pressure rise resulting from increased TPR is equal to the increase in the mean pressure (Δ mean); the remainder of the increase (Δ systolic minus Δ mean) is caused by the only other variable that could account for an additional increase in systolic pressure with advancing age, a decrease in AD. Application of this formulation to published blood pressure data shows that in normotensives the ratio of the contribution toward rising systolic pressure of ↓ AD to ↑ TPR is 1:1 between the ages of 40 and 65 years, whereas in hypertensives it is 2:1. Thus, the natural history of essential hypertension, once established, is one of accelerated arterial stiffening, a mechanism that would contribute importantly to the increasing prevalence of “systolic hypertension” with advancing age.