Prikhodko V. Haemodynamic mechanisms of hypertensive heart in elderly

The systemic, intracardial, cerebral hemodynamics and heart functional state were studied in healthy people, patients with essential hypertension (EH) and isolated systolic hypertension (ISH), post-stroke patients of different age. It was found that age-related changes of systemic hemodynamics, big arterial vessels, 24-hour blood pressure (BP) profile and variability were resulted in elderly healthy subjects in "hypertensive" heart signs that may be definite as "elderly" heart. "Elderly" heart is characterized by signs of left ventricular hypertrophy (LVH) and more frequent myocardial dysfunction during functional tests particularly in subjects with "high normal" blood pressure, hyperkinetic hemodynamics and eccentric LVH. It was established that in elderly healthy people there is correlation between cerebral and systemic hemodynamics parameters. It gives evidence about cerebral autoregulation mechanisms weakening in elderly and old people. It is more pronounced in elderly patients with arterial hypertension. In EH cerebral hemodynamics parameters relate to diastolic BP and general peripheral resistance, when in ISH - with systolic BP, cardiac output and general elastic arterial resistance. LVH in both is associated with flow deceleration in middle cerebral artery. In post-stroke patients with normal and high BP the association between cerebral and systemic hemodynamics is more pronounced. The bigger flow velocity parameters are in patients with hyperkinetic hemodynamics. In post-stroke patients the functional heart state deterioration took place: the quantity of eccentric LVH with systolic dysfunction increased. The differential approaches to antihypertensive therapy in according with LVH and remodeling type were proposed. It was founded that LVH regression possibilities are decreasing in process of aging.