What is the relationship between aging and the development of hypertension?

From the Guidelines

Aging increases blood pressure primarily through structural and functional changes in blood vessels, including arterial stiffening, endothelial dysfunction, and decreased baroreceptor sensitivity, as well as hormonal changes and lifestyle factors that accumulate over time. As we age, our arteries naturally stiffen and lose elasticity due to the breakdown of elastin fibers and increased collagen deposition in arterial walls, leading to higher systolic pressure 1. This arterial stiffening, called arteriosclerosis, means blood vessels can't expand as easily when the heart pumps blood. Additionally, aging often leads to endothelial dysfunction, where the inner lining of blood vessels produces less nitric oxide, a substance that helps blood vessels dilate. Baroreceptor sensitivity also decreases with age, impairing the body's ability to regulate blood pressure effectively. Hormonal changes contribute too, with decreased production of estrogen in women after menopause removing its protective effect on blood vessels. Age-related kidney function decline affects fluid and sodium balance, while increased sympathetic nervous system activity raises heart rate and constricts blood vessels. Finally, lifestyle factors that accumulate over time—such as poor diet, sedentary behavior, and stress—compound these physiological changes, collectively causing blood pressure to rise as we age.

Some key points to consider:

• The prevalence of hypertension increases with age, with over 75% of people over 80 years old meeting the criteria for hypertension 1.
• Isolated systolic hypertension is the predominant form of hypertension in older persons, with systolic blood pressure continuing to rise while diastolic blood pressure decreases after the fifth or sixth decade of life 1.
• Lifestyle modification and pharmacological therapy are essential for managing hypertension in older adults, with a focus on salt restriction, increased intake of vegetables and fruits, weight management, and reducing alcohol intake 1.
• The 2020 international society of hypertension global hypertension practice guidelines recommend annual screening for hypertension in adults 18 years and older, and first-line pharmacological therapy with a single pill combination including a thiazide-like diuretic plus CCB or CCB plus ARB 1.

Overall, the most effective approach to managing hypertension in older adults is a comprehensive one that takes into account the complex interplay of physiological, hormonal, and lifestyle factors that contribute to blood pressure regulation. By prioritizing lifestyle modification, pharmacological therapy, and careful monitoring, healthcare providers can help older adults manage their blood pressure and reduce their risk of cardiovascular disease and other complications.

From the Research

Mechanisms of Aging-Related Blood Pressure Increase

• Aging is known to be a dominant risk factor in the progression of hypertension, with age-associated blood pressure elevation resulting from the aging process in organ systems that regulate blood pressure 2.
• The aging process leads to functional, structural, and mechanical changes in arteries, including endothelial dysfunction, vascular remodeling, inflammation, calcification, and increased stiffness, which contribute to hypertension 3.
• These changes in arteries are closely related to the development of hypertension, and hypertension accelerates and augments age-related vascular remodeling and dysfunction 3.

Effects of Aging on Blood Pressure Regulation

• The increase in blood pressure with age is mostly associated with structural changes in the arteries, especially large artery stiffness 4.
• Isolated systolic hypertension, an elevation in systolic but not diastolic pressure, is the most prevalent type of hypertension in those aged 50 or over 4.
• The most powerful predictor of risk in the elderly is increased pulse pressure due to decreased diastolic and increased systolic blood pressure 4.

Interaction between Aging and Hypertension

• Aging may impact the severity of vascular damage in hypertension, indicating close interactions between biological aging and blood pressure elevation 3.
• Hypertension and aging share common molecular and cellular mechanisms, including aberrant signal transduction, oxidative stress, and activation of pro-inflammatory and pro-fibrotic transcription factors 3.
• Strategies to suppress age-associated vascular changes could ameliorate vascular damage associated with hypertension 3.