Therapeutic Advances: Hypertension in the Elderly

Abstract

The incidence of hypertension and attendant biological disorders (loss of arterial wall elasticity, endothelial dysfunction, insulin resistance) increases with age and so does the frequency of cardiovascular complications. Women have a lower incidence of hypertension and a later—by an average of 10 years—onset of cardiovascular complications. During the premenopausal years, women seem to be relatively protected from cardiovascular events, in part through the effects of estrogen on endothelial function and lipid profile. After menopause however, the incidence of cardiovascular events tends to become similar in both genders, and the severity of such events, in terms of morbidity and mortality, is actually higher in women. The role of hormone replacement for cardiovascular protection has been shown to offer no long-term benefits:  indeed, despite improvement in surrogate endpoints (endothelial function, lipid profile), in long-term prospective randomized trials there was no advantage in outcomes, possibly because benefits are offset by the thrombogenic and carcinogenic properties of estrogen....(excerpt)