Published: 2017-09-23

Profile of vascular age and vascular response among elderly patients receiving antihypertensive therapy

Rama Mohan Pathapati, Bhakthavatsala Reddy Chirra, Parigala Madhavi, Tandayam Abhishek, B. L. Kudagi, Madhavulu Buchineni


Background: Normally the age of the arteries is same as that of the chronological age of the patient. In Hypertensive patients, complex interactions occur between prohypertensive factors, accelerating vascular age. Furthermore, prohypertensive factors to some extent are responsible for non-response to therapy at optimal doses. We assessed the correlation between response to therapy and vascular age in elderly hypertensives, in addition to vascular age and vascular response.

Methods: In this study, we analysed the clinical records of both male and female hypertensive patients above 60 years old. We collected the details of age, gender, body mass index, systolic blood pressure (treated and untreated), diabetes and smoking. Vascular age was calculated using a composite score of these six prohypertensive risk factors. Accelerated vascular age was then derived using the formula vascular age minus chronological age. The optimal vascular response was considered if the patient's therapeutic blood pressures are less than 140/ 90mmHg.

Results: In the present study, data from 517 elderly hypertensive patients were analysed, the mean chronological age, vascular age and accelerated vascular age was 66.74±6.6, 79.46±0.42 and 13.46±6.08 years. Only 32.7% were responders to anti-hypertensive treatment. The pattern of usage of anti-hypertensives in our patients is CCBs 39.10% followed by 30.90% ARB, 22.50% ACEI and 8.90% diuretics. The response in 20.50% of patients was achieved with a single drug, in 9.90% with two drugs and only in 2.30% of patients using three drugs. We found that 78.72% of our study population had vascular age more than ten years of chronological age, among them 66.6% between 60-69 years of chronological age were non-responders. We found a significant correlation (P<0.05) between vascular age and non-response to treatment.

Conclusions: The majority (98.6%) of our patients had vascular age more than 80 years due to various risk factors of cardio vascular disease. Non-responsiveness to therapy showed a significant relationship with vascular age.


Elderly hypertensives, Non-laboratory based vascular age, Response to antihypertensive therapy

Full Text:



Harvey A, Montezano AC, Lopes RA, Rios F, Touyz RM. Vascular Fibrosis in Aging and Hypertension: Molecular Mechanisms and Clinical Implications. The Canadian Journal of Cardiology. 2016;32(5):659-68.

Baker PB, Baba N, Boesel CP. Cardiovascular abnormalities in progeria. Case report and review of the literature. Archives of Pathology & Laboratory Medicine. 1981;105(7):384-6.

Franklin SS, Jacobs MJ, Wong ND, Gilbert J, Lapuerta P. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives. Hypertension. 2001;37(3):869-74.

Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: Current outcomes and control in the community. Jama. 2005;294(4):466-72.

Alderman MH. Resistant hypertension: a clinical syndrome in search of a definition. American journal of hypertension. 2008;21(9):965-6.

Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51(6):1403-19.

Cunningham G, Dodd TR, Grant DJ, Mcmurdo ME, Michael R, Richards E. Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment. Age and ageing. 1997;26(5):375-82.

Brown MJ, Castaigne A, de Leeuw PW, Mancia G, Palmer CR, Rosenthal T, et al. Influence of Diabetes and Type of Hypertension on Response to Antihypertensive Treatment. 2000;35(5):1038-42.

D'Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743-53.

Gaziano TA, Young CR, Fitzmaurice G, Atwood S, Gaziano JM. Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort. The Lancet. 2008 Mar 21;371(9616):923-31.

Pandya A, Weinstein MC, Gaziano TA. A Comparative Assessment of Non-Laboratory-Based versus Commonly Used Laboratory-Based Cardiovascular Disease Risk Scores in the NHANES III Population. PLoS ONE. 2011;6(5).

Aronow WS. Treatment of systemic hypertension. American Journal of Cardiovascular Disease. 2012;2(3):160-70.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Jama. 2003;289(19):2560-71.

Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. Jama. 2005 Jul 27;294(4):466-72.

Sarafidis PA, Bakris GL. State of hypertension management in the United States: confluence of risk factors and the prevalence of resistant hypertension. The Journal of Clinical Hypertension. 2008;10(2):130-9.

Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005 Oct 11;112(15):2254-62.

Mahmud A, Wadi H, Feely J, Silke B. Cigarette smoking reduces blood pressure response to antihypertensive treatment in newly diagnosed hypertensive patients. Journal of hypertension. 2015 Jun;33(l1):e94.

Heineke J, Molkentin JD. Regulation of cardiac hypertrophy by intracellular signalling pathways. Nature reviews Molecular cell biology. 2006 Aug;7(8):589-600.