L'ipertensione arteriosa nell'anziano: dalla fisopatologia alle evidenze cliniche

Arterial hypertension is a very common condition in the elderly, and it is associated with increased cardiovascular morbidity and mortality. In this agegroup, stiffening of the aorta and other major arteries with increased left ventricular hemodynamic load is frequently associated with the detection of isolated systolic hypertension. Increased cardiovascular risk associated with systolic hypertension has been known for years and it has been confirmed in recent metaanalyses. Recent clinical trials have demonstrated that the benefit of systolic blood pressure reduction below 150 mm Hg can be extended also to the population of the octuagenarians. Current evidence indicates that the reduction of cardiovascular risk obtained with treatment of systolic hypertension in the elderly does not depend from use of specific drug types, and cumulative analyses report comparable benefits with all the agents that are commonly prescribed as a first choice. This review article summarizes the clinical evidence currently available on this topic and provides some directions for treatment strategy.