It is commonly accepted that the incidence of osteoporosis, as well as hyprtension and diabetes, increases with age. With the expansion of the elderly portion of the population in society, the number of cases of osteoporosis and its related fractures must correspondingly increase. Regarding the effect of the level of decreased bone mass or bone mineral density of patients with vertebral body or hip fracture, the incidence rate of fractures significantly increases when the bone mass level of patients becomes less than -3 S. D. of the peak bone mass level at each of the respective sites. As a result, areas of under -3 S. D. area of to peak bone mass level are considered to be fracture risk area. When treating osteoporosis patients, special consideration must be given to other age-related complications. One third of hip fracture patients already have dementia, hypertension, or cerebrovascular disorders at the time of injury. Exercise and weight bearing are important for the treatment and prevention of osteoporosis because of their positive influence on the muscles and the bone tissue of the patients.
In order to define the factors responsible for cardiac hypertrophy in elderly hypertension, blood pressures and non-hemodynamic humoral parameters were correlated with echocardiographic left ventricular mass (LVM) in 30 elderly hypertensive patients and 30 age-matched normotensive subjects with a mean age of 65 years. Arterial blood pressures were obtained either at the clinic, after supine rest, during naximal exercise test, or with a 24 hour ambulatory monitoring device at 10 minute intervals. Interventricular septum and posterior wall thickness, but not end-diastolic diameter, were significantly increased in the hypertensives than in the normotensives. LVM was significantly correlated with all of to blood pressure parameters, having the strongest association with the mean of ambulatory systolic blood pressures (r=0.65, p<0.001). On the other hand, plasma norepinephrine (r=0.09), plasma renin activity (r=-0.14), and atrial natriuretic factor (r=-0.08), though known to influence cardiac adaptation to hypertrophy in young or middle aged hypertensives, were not correlated wit LVM. These results suggest that the heart in elderly hypertension is characterized by concentric hypertrophy, the only significant determinant of which appears to be a hemodynamic factor. Unlike younger patients, sympathetic nervous and renin-angiotensin systems may not play an important role in the development of cardiac hypertrophy in the elderly.
To study the significance of left ventricular (LV) diastolic filling in elder patients with hypertension (HT), cardiac blood pool imagings with Tc-99m were obtained at rest in 17 normal subjects and 28 patients with systemic hypertension. The patients with hypertension did not show any evidence of coronary heart disease, renal insufficiency or other disease. Moreover, they showed normal LV ejection fraction (LVEF) and normal LV wall motion. They were divided into 4 groups: 1) normal-young (<60 years old, n=10), 2) normal-old (≥65 years old, n=7), 3) HT-young (<60 years old, n=15), 4) HT-old (≥65 years old, n=13). From the LV volume curve and its first differentiation curve, LVEF, mean first third ejection rate (ERm) and peak ejection rate (PER) were obtained as indices of the LV systolic function, and LV diastolic filling rate during the first third of diastole (FRm) and peak filling rate (PFR) were obtained as indices of LV diastolic function. All indices of LV systolic function were similar in all groups. In contrast, LV diastolic indices (FRm and PFR) of older groups were significantly lower than those of young groups both in HT and normal. Also, LV diastolic indices in HT groups decreased significantly in comparison with normal groups of the same age group. Among diastolic indices, FRm could distinguish patients with HT from normal subjects of the same age group more accurately than PFR. In normal subjects. FRm correlated with age (r=-0.490, p<0.05) and ERm (r=-0.489, p<0.05). In addition to age ERm, FRm correlated wit LV wall thickness measured by M-mode ecocardiograpy (r=-0.566, p<0.05) in patients with HT. In HT-old, the correlations between FRm and LV wall thickness and between FRm and ERm were more significant than in HT-young. These results suggested; 1) In elderly patients with HT, the impairment of early diastolic filling of LV was more prominent than in young patients with HT. 2) In elder patients with HT, LV diastolic abnormality was influenced more highly by the degree of LV hypertrophy than young patients with HT. 3) These diastolic abnormalities may cause systolic dysfunction in elderly patients with HT.
To study the hemodynamic characteristics of elderly hypertensives, elderly subjects (≥65 years old) were divided into normotensives (NT, n=15), borderline hypertensives (BH, n=10) and established hypertensives (EH, n=20) and compared each group with similarly divided middle aged subjects (≥35 years old, <65 years old), NT (n=23), BH (n=112) and EH (n=79). An attempt was also made to clarify what factor is most important regarding left ventricular hypertrophy (LVH) in elderly hypertensives. The results showed that with advancing age, cardiac output and stroke volume decrease (p<0.05), total peripheral resistance and volume-elasticity index increase (p<0.05), daily lability of systolic pressure increases and the baroreceptor slope increases. Furthermore, almost all of these tendencies are exacerbated by hypertension (p<0.05). With advancing age, pressure response to infused noradrenaline is enhanced (p<0.05), but on exercise, there are wide variations in each group and no distinct differences were observed. Echocardiographic examinations revealed LVH in 50% of elderly hypertensives. There were no apparent differences between both groups with or without LVH in their family and personal histories of hypertension, resting hemodynamics, hormonal examinations and hypertensive complications other than the heart. However, on exercise, the pressure response was more enhanced in the group with LVH than in the group without LVH (p<0.05). There was no significant correlation between resting systolic pressure (SBP) and left ventricular mass index (LVMi), but, there was relatively good correlation (r=0.563, p<0.05) between SBP at peak exercise and LVMi. Using delta SBP/delta HR as a parameter of pressure responsibility on exercise test, 9 out of 10 patients with LVH showed above 1.0, while all of 10 patients without LVH showed under 1.0. Pressure response to infused noradrenaline seems to be more enhanced in the group with LVH than in the group without LVH. It was concluded that enhanced pressure responsiveness to recurring stress might induce or at least sustain LVH in hypertensives, due to enhanced alpha-adrenoceptor responsiveness.
94-year-old male patient, with orthostatic hypotension, possibly due to impairment of vasoconstriction and parasympathetic nervous system dysfunction was reported. This patient experienced faintness and lower muscle weekness on standing. The blood pressure was 180/90mmHg in a supine position, while it significantly decreased to 100/58mmHg in an upright position. There was no evidences indicating the presence of organic brain diseases, cardiovascular diseases, and endocrine diseases. plasma catecholamine, renin, aldosterone, and vasopressin levels at rest were within normal range. Thus, the cause of orthostatic hypotension of this patient was unknown. His systolic blood pressure decreased by 70mmHg, and his diastolic blood pressure also decreased by 25mmHg in response to a 70° head-up tilting test (170/71→100/46mmHg). Plasma vasopressin level significantly increased in response to this test (0.62→67.2pg/ml). Plasma catecholamine levels also increased (Adr 0.01→0.10ng/ml, Ndr 0.05→0.22ng/ml). Other autonomic nervous system examinations revealed normal responses to mental arithmatic test, hyperventilation test, cold pressure test, and adrenalin test. However, the results of the carotid occlusion test, acetylcholine test, atropine test, phenilephline test were considered to be abnormal. From these findings, we concluded that the functions of sympathetic nervous system were almost intact, while the parasympathetic functions were impared in this case. The orthostatic hypotension of the patient as effectively treated with fludrocortisone. This report suggests that impairment of vasoconstriction and parasympathetic neurodysfunction might be involved in the development of orthostatic hypotension in the elderly.