Background: Systolic blood pressure and pulse pressure tend to increase with age in the general population, with increase in cardiovascular risk. Whether this holds in treated hypertensive patients remains unknown.
Methods: Encounters from a university-based cardiology clinic with broad referral base were analyzed for blood pressure (BP), pulse pressure (PP), and lipids by age in patients with hypertension as a diagnosis. Differences between groups were compared using 2-tailed student t-test.
Results: 200 encounters were analyzed: 42% (84) were ≥ 60 years old (average 68 ± 8; elderly); 58% (116) were < 60 years old (average 48 ± 9; young). Systolic BP (SBP) and pulse pressure (PP) were 134 ± 20 mmHg and 55 ± 18 mmHg in elderly compared with 128 ± 18 mmHg and 42 ± 13 mmHg in young, respectively (P < 0.05). Total cholesterol and LDL were 166 ± 35 mg/dL and 92 ± 32 mg/dL in elderly compared with 171 ± 48 mg/dL and 95 ± 38 mg/dL in young, respectively (P = NS).
Conclusion: Elderly patients remain at very elevated risk for atherosclerotic cardiovascular events, with mounting healthcare costs. Efforts to improve cardiac risk factors in this vulnerable group are of paramount importance. Higher SBP and PP in the elderly compared to young patients likely reflects increased arterial stiffness, resulting in a wider pulse pressures. Lack of compliance with medications is unlikely since these patients had insurance and their total cholesterol and LDL levels were adequately controlled with medications, not significantly different compared to young patients. White-coat-hypertension is another potential explanation in the elderly. A trend towards higher use of nonsteroidal anti-inflammatory agents (NSAIDs) due to more prevalent arthritis in the elderly may have contributed to the blood pressure difference. Whether prescribing non-NSAID medications would improve compliance with exercise, weight loss, and blood pressure control in elderly patients is subject of further studies.