Screening for hypertension-mediated organ damage and aetiology: still of value after 65 years of age?

• Published in: Journal of geriatric cardiology : JGC 2022-11, Vol.19 (11), p.791-801
• Main Authors: Thiolliere, Delphine, Harbaoui, Brahim, Falandry, Claire, Bonnefoy, Marc, Lega, Jean-Christophe, Lantelme, Pierre, Courand, Pierre-Yves
• Format: Article
• Language: English
• Subjects: Cardiology and cardiovascular system; Geriatry and gerontology; Human health and pathology; Life Sciences; Santé publique et épidémiologie
• ISSN: 1671-5411
• DOI: 10.11909/j.issn.1671-5411.2022.11.005

Secondary forms and hypertension-mediated organ damage (HMOD) may differ between younger and older hypertensive patients. The aim of the present study was to explore the specificity of HMOD and secondary forms in patients ≥ 65 years in comparison to younger ones in a contemporary cohort. We analysed 938 patients recruited between 2004 and 2014 (Cardiology department, Croix-Rousse Hospital, Lyon) who had at baseline HMOD and secondary forms screening among them 190 were ≥ 65 years. The mean (2.1 ± 0.8 1.2 ± 0.9, < 0.001) and frequency of HMOD (96.3% . 72.9%, 0.001) was higher in patients ≥ 65 years than younger ones. Carotid femoral pulse wave velocity > 10 m/s was the most frequent HMOD in patients ≥ 65 years (90.1%), while echocardiographic left ventricular hypertrophy was the most common in the younger patients (45.0%). Among ECG left ventricular indexes, only R wave in aVL lead was significantly more frequently observed in patients ≥ 65 years (32.6%) than in younger ones (19.0%, 0.001). The frequency of secondary hypertension was not significantly different between younger and older patients (respectively; 30.5% 27.8%, = 0.487). The most frequent aetiology was primary aldosteronism regardless of age, followed by renovascular hypertension (6.3% 3.3%, = 0.038). Among older patients, 3.2% were treated with adrenalectomy and 6.3% with percutaneous transluminal renal angioplasty. Extensive screening of HMOD in older patients may be questionable as nearly all patients had one; aetiology must however be explored as a third of older patients had a secondary form.