Eliminate age-related changes in the work of blood vessels. Age-related changes in the cardiovascular system

Question: What advice can you give to people who want to lose weight?

Answer: Hello, Ksenia Sergeevna! We talk about moderation all the time. I don't think people know what moderation is. You can eat foods that you really like, but eat them a little less. It is not at all necessary to give them up completely. Don't even think about giving them up! Better try to diversify your favorite dishes with others that are equally tasty and healthy.

Question: Doctor, have you ever broken your diet?

Answer: Hello Alexandra! I became a dietician not because I love to study nutrients, but because I love to eat. Ironically, when I wrote an article about stomach shrinkage, my own stomach was enlarging. I gained 9 kilograms! My cholesterol level was 238! I realized that I was not following my own recommendations. I got an alarm after checking my cholesterol levels. In a month, I lost 5 kilograms and my cholesterol dropped to 168. The key role was played by the plate of healthy oatmeal, which I ate every morning. I added a handful of almonds, pistachios, walnuts, pecans to the oatmeal, as well as some cherries, raspberries, and pomegranates. Every day I ate this healthy food. In addition, I ate three pieces of fatty fish a week. I also did physical activity for half an hour every day. Most importantly, I did not give up any of my favorite dishes. In fact, the day I was about to check my cholesterol level again, I stopped by a friend of mine who made a dinner of pork chops and different sauces. I ate one chop and realized that perhaps this is not the most a good idea the day I'm going to check my cholesterol level. But the most interesting thing was that my cholesterol level dropped by 70 points. Imagine what my cholesterol level would be if I hadn't eaten the pork chop before!

Question: What is your opinion on hormones and menopause? Do they slow down aging?

Answer: Good day! The concept of estrogen replacement therapy is based on this. The only difficulty lies in the side effects of this concept, which potentially increase a woman's risk of developing heart disease. There are estrogen-rich foods that can help keep skin pleasant and soft. Soy is a good source of these substances. Beans and legumes generally contain large amounts of phyto-estrogens. Flax is also a source of these substances. The main thing is that these foods should be consumed throughout life, and not wait until you turn 50. Start eating these foods from childhood, but in moderation. Many people believe that the more soy or other foods they eat, the healthier they will be. In Japanese culture, for example, soy is not a staple food. A handful of green soybeans and a little tofu should be sufficient. You don't need to eat a whole pound of tofu. A lot doesn't mean useful.

Question: How strongly does genetic data influence the aging process? Is there anything you can do to control your genes?

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Karaganda State Medical University

Department of Histology

Test

Features of the cardiovascular vascular system in elderly people

Completed: Art. 3072gr. Novozhenova V.

Checked by: teacher Abeldinova G.K.

Karaganda 2014

Introduction

1. Cardiac system

2. Vascular system

Bibliography

Introduction

The aging process is characterized by gradual involutive changes in most organs, which entails changes in their functions, due to the gradual disappearance of the active parenchyma in the organ by replacing it with inactive tissue (fatty or connective) or a progressive decrease in the size of the organ. Old age is an integral process, since the phenomena of old age and involution develop in all organs and systems of the body.

Purpose of the study: to consider and study the morphology of the blood system and its age characteristics.

To achieve this goal, the following tasks were solved:

1. Consider the components of the cardiovascular system and their morphology.

2. Determine the age characteristics of the cardiovascular system.

1. Cardiac system

cardiomyocyte thrombogenic blood arterial

With age, significant changes occur in the heart itself. For 70 years of a person's life, the heart pumps 165 million liters of blood. His contractile ability depends primarily on the state of myocardial cells. Such cells of cardiomyocytes in mature and elderly people are not renewed and the number of cardiomyocytes decreases with age. Upon death, they are replaced by connective tissue. But the body tries to compensate for the loss of myocardial cells by increasing the mass (and hence the strength) of each working myocardial cell. Naturally, such a process is not unlimited, and gradually the contractile ability of the heart muscle decreases.

The valvular apparatus of the heart also suffers with age, and changes in the bicuspid (mitral) valve and the aortic valve are more pronounced than in the valves of the right chambers of the heart. Valve leaflets lose their elasticity in old age, and calcium can be deposited in them. As a result, valvular insufficiency develops, which, to a greater or lesser extent, disrupts the coordinated movement of blood through the heart. Rhythmic and sequential contractions of the heart are provided by special cells of the cardiac conduction system.

2. Vascular system

The main changes that occur in large arterial trunks are sclerotic thickening of the inner membrane (intima), atrophy of the muscle layer, and a decrease in elasticity. Physiological hardening of the arteries decreases towards the periphery. All other things being equal, changes in the vascular system are more pronounced on the lower limbs than on the upper ones. Morphological studies are confirmed by clinical observations. When considering age-related changes in the speed of propagation of the pulse wave in different parts of the large arterial vessels, it was noted that with age there is a regular increase in it, an increase in the elastic modulus. Therefore, an increase in the speed of propagation of the pulse wave, exceeding the age standards, is an important diagnostic sign of atherosclerosis.

Age-related changes in arterial vessels determine their insufficient ability not only to expand, but also to narrow. All this, along with altered regulation of vascular tone as a whole, disrupts the adaptive capacity of the circulatory apparatus. First and foremost, the large arterial vessels of the systemic circulation, especially the aorta, change, and only in older ages the elasticity of the pulmonary artery and its large trunks decreases. Along with an increase in the rigidity of arterial vessels, loss of elasticity, there is an increase in the volume and capacity of the arterial elastic reservoir, especially the aorta, which to a certain extent compensates for the disturbed functions of the elastic reservoir. However, at a later age, the increase in volume does not parallel the decrease in elasticity. This disrupts the adaptive abilities of both the large and the small circle of blood circulation.

Rheography of peripheral vessels and rheoencephalography made a significant contribution to the study of the viscoelastic properties of arterial vessels. It was found that with age, the elastic properties of peripheral arterial and cerebral vessels decrease, as evidenced by the change in the shape of the rheogram curve and its temporal indicators (decrease in the amplitude of the rheographic wave, its slow rise, rounded, often arcuate apex, smoothness of the dicrotic wave, increase in the propagation velocity pulse wave, etc.). Age-related changes, along with large arterial vessels, also affect the capillary network. Pre- and postcapillaries, the capillaries themselves, are characterized by the phenomena of fibrosis and hyaline degeneration, which can lead to a complete obliteration of their lumen. With increasing age, the number of functioning capillaries per tissue unit decreases, and the capillary reserve also decreases significantly. Moreover, on the lower limbs, the changes are more pronounced. Areas without capillary loops are often found - fields of "baldness". The considered symptom is associated with complete obliteration of the capillaries, which is confirmed by histological studies of the skin. There are similar changes in the capillaries during microscopy of the conjunctiva of the eyeball. With aging, the shape of the capillaries changes.

They become convoluted, elongated. The spastic form of capillary loops with narrowing of the arterial and venous branches prevails, and the spastic-atonic form - with narrowing of the arterial and expansion of the venous branches. These changes in the capillaries, along with age-related changes in the rheological properties of the blood, cause a decrease in capillary blood circulation and thereby the oxygen supply of tissues. On the one hand, slowing capillary blood flow, on the other, lengthening the intercapillary distance, as a result of a decrease in the number of functioning capillaries, and thickening of the basement membrane due to its multilayer nature, significantly worsen the conditions for oxygen diffusion into the tissue.

Conducted together with K.G. Sarkisov, A.S. Stupina (1978) studies of the state of capillaries in skin biopsies by the method of electron microscopy showed that with age there is a thickening of the basement membrane of capillaries, collagenization of fibrils, a decrease in pore diameter, and a decrease in pinocytosis activity. These changes lead to a decrease in the intensity of transcapillary metabolism. In this regard, one can agree with the statements of P. Bastai (1955) and M. Burger (1960), which put forward changes in the microcirculation system as one of the causes of aging. A significant decrease in renal blood circulation with aging has been shown, which is directly related to a decrease in microvascularization. Endoscopic examinations of the gastric mucosa and biopsies taken showed a decrease in the number of microvessels.

A significant decrease in muscle blood flow during aging was established, both at rest (MCP) and maximum muscle blood flow (MMC) when performing dosed physical activity. Such a decrease in MMC indicates a significant limitation of the functionality of the microcirculatory system in skeletal muscles, which is one of the reasons for the limitation of muscle performance. Considering the reasons for the decrease in muscle blood flow with aging, the following circumstances should be taken into account: age-related changes in central hemodynamics play a certain role - a decrease in cardiac output, processes of physiological arteriosclerosis of arterial vessels, deterioration of the rheological properties of blood. However, age-related changes in the microcirculatory link are of leading importance in this phenomenon: obliteration of arterioles and a decrease in muscle capillarization.

With age, starting from the fourth decade, endothelial dysfunction increases, both of large arterial vessels and at the level of the microcirculatory vascular bed. A decrease in endothelial function significantly affects changes in intravascular hemostasis, increasing the thrombogenic potential of the blood. These changes, along with age-related slowing down of blood flow, predispose to the development of intravascular thrombosis, the formation of atherosclerotic plaques.

With age, there is a slight increase in blood pressure, mostly systolic, final and average dynamic. Lateral, shock and pulse pressure also increases. The increase in blood pressure is mainly associated with age-related changes in the vascular system - loss of elasticity of large arterial trunks, an increase in peripheral vascular resistance. The absence of a significant increase in blood pressure, primarily systolic, is largely due to the fact that with aging, along with the loss of elasticity of the large arterial trunks, especially the aorta, its volume increases and cardiac output decreases. In old age, the coordinated relationship between the various links of the circulatory system is disturbed, which manifests itself as an inadequate response of arterioles to changes in the volume of circulation. Expansion of the venous bed, decrease in tone, elasticity of the venous wall are the determining factors in the decrease in venous blood pressure with age.

The progressive decrease in the lumen of small peripheral arteries, on the one hand, reduces blood circulation in the tissues, and on the other, causes an increase in peripheral vascular resistance. However, it should be noted that behind the same type of changes in the total peripheral vascular resistance, its different topography of the regional tone shifts is hidden. Thus, in the elderly and old people, the total renal vascular blood resistance increases to a greater extent than the total peripheral vascular resistance.

As a result of the loss of elasticity of large arterial trunks, the activity of the heart becomes less economical with age. This is confirmed by the following facts: firstly, in the elderly and the elderly, compared with young people, there is an increased energy expenditure by the left ventricle of the heart per 1 liter of the minute volume of blood circulation (IOC); secondly, with age, the IOC significantly decreases, however, the work performed by the left ventricle in 1 min practically does not change; third, the relationship between total elastic resistance (Eo) and peripheral vascular resistance (W) changes. According to the literature, the indicator (Eo / W) characterizes the ratio between the amount of energy expended by the heart directly for the movement of blood through the vessels, and the amount that is accumulated by the walls of the vessels.

Thus, the presented facts show that due to age-related changes in large arterial vessels, their elasticity is lost and thus conditions are created under which the heart spends more energy to promote blood. These changes are especially pronounced on the part of the systemic circulation and cause the development of compensatory hypertrophy of the left ventricle and an increase in heart mass.

Bibliography

1. Research by O.V. Korkushko. State Institution "Institute of Gerontology of the Academy of Medical Sciences of Ukraine", Kiev.

2. Age histology Publisher: A.S. Pulikov. Phoenix, 2006.

3. Volkova O. V., Pekarsky M. I. Embryogenesis and age histology of human internal organs M .: Medicine, 1976

4. Age-related histology: Tutorial Editor: Mikhailenko A., Guseva E. Phoenix, 2006

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Aging of the cardiovascular system

Age-related changes in the cardiovascular system, while not in themselves the primary mechanism of aging, largely determine the intensity of its development.

They, firstly, significantly limit the adaptive capabilities of an aging organism, and secondly, they create the prerequisites for the development of pathology, which is the main cause of human death - atherosclerosis, hypertension, coronary heart disease and brain disease.

Most researchers agree that systolic blood pressure (BP) level of the blood rises with age (Fig. 29), while diastolic changes insignificantly.

Figure: 29. Age-related dynamics of blood pressure in the right radial (A) and right femoral (B) arteries (arterial oscillography technique).

The ordinate shows the maximum (1), minimum (2) and average dynamic (3) blood pressure, mm Hg. Art .; abscissa - age, years.

With age, the average dynamic blood pressure, lateral, shock and pulse pressure also increases. Blood pressure is a difficultly regulated parameter determined by vascular resistance and cardiac output. As you can see from the table. 27, the same blood pressure level can be maintained in different age periods due to unequal shifts in total peripheral vascular resistance and cardiac output (Frolkis et al., 1977a, 1979).

Table 27. Indicators of hemodynamics and contractility of the myocardium in animals of different ages

It is of interest to compare hemodynamic parameters in phylogenetic terms, to compare them in organisms with different life expectancy. Attention is drawn to the fact that in short-lived species (rats, rabbits), blood pressure does not change significantly, while in longer-lived species (people, dogs) it increases. At the same time, it was noted that an increase in blood pressure is mainly associated with age-related changes in the vascular system - a loss of elasticity of large arterial trunks, an increase in peripheral vascular resistance. A decrease in cardiac output against the background of an increase in vascular resistance protects against a sharp increase in blood pressure. There is a difference in age-related changes in human blood pressure in different countries, in different regions of the Russian Federation. So, the lowest level of systolic pressure in old men and women is in Abkhazia, and then in Ukraine, Moldova; higher - among residents of Belarus and Lithuania. Inhabitants of Armenia and Kyrgyzstan have lower blood pressure than Muscovites and Leningraders (Avakyan et al., 1977). With age, there is a decrease in venous blood pressure. According to Korkushko (1968b), when it is measured in a bloody way using the Waldman apparatus in the median vein in the elbow bend with a horizontal body position in the age group 20-40 years, the level of venous pressure is on average 95 ± 4.4 mm of water. Art., in the seventh decade - 71 ± 4, in the eighth - 59 ± 2.5, in the ninth - 56 ± 4.4, in the tenth - 54 ± 4.3 mm of water. Art. (R
Figure: 30. Changes in basic hemodynamic parameters with age (study with dilution of the dye T-1824). On the ordinate axis - SV, ml (A), SI, ml / m2 (B), minute blood volume, l / min (C) and SI, l * min-1 * m-2 (G); abscissa - age, years. According to Brandfonbrener et al. (Brandfonbrener et al., 1955), a decrease in cardiac output has been noted since the third decade, and from 50 years of age and older, cardiac output decreases by 1% per year due to the systolic volume and a slight decrease in the number of heartbeats (the dye dilution method was used - Evans blue ). At the same time, it was noted that the decrease in cardiac output was more pronounced than the decrease in oxygen consumption and CO2 production (oxygen consumption decreased by 0.6% per year). Strandell (1976) believes that a drop in cardiac output with age is associated with a decrease in oxygen consumption.

Turner (1977) in the elderly also observed a decrease in cardiac output (dye dilution technique). In the young, the cardiac index (SI) was 3.16 ± 0.19 l * min-1 * m-2, in the elderly - 2.53 ± 0.11, in the old - 2.46 ± 0.09 l * min-1 * m-2, the stroke index was 46.5, respectively. ± 2.6, 42.2 ± 1.8 and 39.6 ± 1.4 ml / m2.

Moreover, in older people, compared with young people, the decrease in IOC was associated with a decrease in the number of heart contractions (HR), while in old people there was also a significant decrease in SV.

Table 27 presents data on changes in hemodynamic parameters with aging in rats, rabbits and dogs (Frolkis et al., 1977b). They have a significant decrease in the minute blood volume, cardiac index. It is important that these animals do not suffer from spontaneous atherosclerosis, whereas it is known that atherosclerosis is almost always found in people over 60 years of age. A decrease in cardiac output in old animals indicates that this is an age-related and not a pathological phenomenon. Attention is drawn to the fact that different types the participation of changes in the rhythm of heart contractions in the mechanism of the fall in cardiac output is not the same in animals. It was found that with age, the functional reserve of cardiac output decreases above the basal level during submaximal physical exertion (Korkushko, 1978; Strandell, 1976). Experimental data also testify to the limitation of the ability to adapt to stress (Frolkis et al., 1977b). With experimental coarctation of the aorta in old animals, acute heart failure often develops in 48% of cases. As seen from Fig. 31, 4-6 days after coarctation of the aorta in the so-called emergency phase in old animals, the IOC, SV, and the maximum rate of increase in intraventricular pressure drop significantly.

Figure: 31. Systolic pressure in the left ventricle of the heart (L), maximum rate of increase in intraventricular pressure (B) and myocardial contractility index (C) in% of the initial values \u200b\u200bin adult (I) and old (II) rats on the 4th-6th ( 1) and 14-16th (2) days after experimental coarctation of the aorta.

Basal metabolism decreases with age. That is why a decrease in the minute volume of blood in the elderly and old people is considered by some as a natural reaction of the cardiovascular system to a decrease in tissue demand for oxygen delivery (Burger, 1960; Korkushko, 1968a, 1968b, 1978; Strandell, 1976; Tokar, 1977). However, the decrease in oxygen consumption falls less than cardiac output, and this contributes to the occurrence of circulatory hypoxia. Compensatory mechanisms aimed at optimal oxygen supply to tissues with reduced cardiac output are an increase in the arteriovenous oxygen difference and a change in the oxyhemoglobin dissociation curve (shift to the right). In the elderly and old people, against the background of decreased cardiac output, an active regional redistribution of organ fractions of cardiac output is observed. Despite the decrease in IOC, the cerebral and coronary fractions of cardiac output are quite high (Mankovsky, Lizogub, 1976), while the renal (Kalinovskaya, 1978) and hepatic (Landowne et al., 1955; Kolosov, Balashov, 1965) are significantly reduced.

The absolute values \u200b\u200bof the central blood volume (CTC) do not change with age. However, its ratio to the mass of circulating blood (MCC) indicates a relative increase. At the same time, an increase in the SV relative to the CSC was noted (Korkushko, 1978).

All this indicates a change in the conditions of blood flow to the heart and its deposition in the intrathoracic region. The relative increase in the central blood volume in elderly and senile people is associated with an increase in the residual blood volume in the cardiac cavities. It is also important to increase the capacity (volume) of the aorta, its ascending part and arch. MCC practically does not change with age. The ratio of the mass of circulating blood to the minute volume of blood gives an idea of \u200b\u200bthe time of the complete circulation of blood. This indicator increases with age. At the same time, a slowdown in the time of blood flow was also noted in other parts of the vascular system: hand-ear, hand-lungs, lungs-ear; the time characterizing the central volume (intrathoracic) of blood circulation increases (Fig. 32).

Figure: 32. Age-related changes in blood flow velocity. The ordinate is the time of intrathoracic (A) and complete (B) blood circulation and blood flow in the area hand - lung (C), lung-ear (D) and hand-ear (D), s; abscissa - age, years.

N.I. Arinchin, I.A. Arshavsky, G. D. Berdyshev, N.S. Verkhratsky, V.M. Dilman, A.I. Zotin, N.B. Mankovsky, V.N. Nikitin, B.V. Pugach, V.V. Frolkis, D.F. Chebotarev, N.M. Emanuel

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Age-related changes in the cardiovascular system

According to the theory of evolution, aging is an invariable biological law. The human body is designed for a certain period of work. The aging program is embedded in our genetic apparatus, it cannot be avoided. Nevertheless, gerontologists have come to a consensus that the real life span is 110-120 years. The period of active creative longevity may well reach 90-100 years, and there are many examples of this.

Scientists also found out that longevity depends on inherited genes only by 25-30%. The rest is the influence of the environment. It makes a significant contribution to the formation of the body already in the womb. Then environmental and social conditions begin to play a role. Where a person lives, what he eats, what he learns, acquires good or bad habits, fate treats him harshly or not, and other factors together determine what the person's life will be.

Gerontologists have determined the age at which the gradual aging of the body begins - about 20 years. The processes of growth and maturation of some systems in humans lasts up to 21 years for women and up to 25 years for men. But from about 20 years old, as soon as the thymus gland (thymus), the main organ of immunity, begins to fade, age-related changes begin in all organs and systems. Since all tissues and organs are composed of cells, aging begins at the level of the cell. Attacks of the external environment, own metabolic products - this is what the cell must be able to defend against. As soon as the "defense" weakens and the cell is no longer able to work fully, a gradual extinction begins at the level of the organism.

The main role in the aging process is assigned to the accumulation of free radicals and toxic metabolic products of the cell itself. It is known that a certain percentage of the oxygen necessary for life is converted into a “chemical weapon” - free radicals. A small amount of these molecules are helpful and help fight infections. Free radicals are controlled by complex intracellular mechanisms. With unfavorable effects on the body, a very large amount of free radicals is formed in the cells. Especially a lot of them arise when living tissues are irradiated.

With an excess of free radicals, as well as with a failure of defense mechanisms, the amount of free radicals goes out of control and the destruction of cell membranes begins, disease and cell death. The intake of special antioxidant substances can support the cell's self-healing program, the best of which are found in natural raw materials - herbs and plants. Gerontologists identify another reason for the acceleration of the aging process of cells. If the cells do not promptly remove their own metabolic poisons (CO2, aldehydes, etc.), the living conditions of the cell deteriorate, which is fraught with premature aging at the level of the organism.

A sufficient number of capillaries, their functionality, as well as the well-coordinated work of blood vessels to deliver and drain blood, contribute to the maintenance of a healthy metabolism in the cell, and hence the overall functionality of all organs and systems. Thus, in one phrase, aging is a gradual decline in the vital properties of cells.

However, due to physiological, biochemical and other mechanisms of compensation, the deterioration of the body's activity does not appear immediately, but only when most of its cells fail. Therefore, signs of old age in a person appear, as a rule, after a period of maturity, the boundary of which is conventionally considered the age of 60 years.

As a result of numerous experiments, gerontologists have concluded that the earlier the prevention of aging begins, the more effective it is and the longer the body remains young and healthy. Taking control of the aging process is not too late at any age. The optimal age for starting the fight against age-related changes was determined - 25 years.

The processes of age-related changes do not begin in different tissues and organs at the same time and proceed with different intensities. The circulatory system is one of the first to be affected. Changes appear in all components of the cardiovascular system, but above all, in the arteries and capillaries.

In the aorta and large vessels, the greatest changes occur on the inner membrane - the endothelium, which gradually loses its smoothness and elasticity due to atherosclerotic and sclerotic (Cicatricial) processes. Lipid spots - the first manifestations of vascular atherosclerosis by the age of 25-30 are found in large arteries (primarily in the aorta) and in the vessels of the heart, and by 35-45 years - in the arteries of the brain.

Atherosclerotic spots and stripes, overgrown with fatty compounds or saturated with calcium salts, form thickenings that impede the movement of blood. With age, the amount of fat-containing and calcareous deposits increases, impairing the blood supply to organs, primarily the heart and brain. Atherosclerosis can occur as an independent disease, but is often combined with hypertension and diabetes mellitus.

In addition to atherosclerosis, the formation of scar (connective) tissue at the site of endothelial damage can be provoked by infectious, chemical agents or immune complexes. The connective tissue is strong but not elastic. Sclerotic changes disrupt the smoothness of the endothelium and contribute to disorders of local regulation of arterial tone. The middle membrane of large vessels also undergoes changes with age. Elastic fibers become coarser, their "springy" properties are reduced. As a result, the vessels become rigid, not flexible and less able to expand by blood pressure.

1. Healthy vein

2. Vienna with age-related changes

Vessels deprived of elasticity function poorly; now they look like rigid metal tubes, and not like a flexible hose that can expand under blood pressure and regain its size again, directing the blood flow further. Gradually, with age, the hard working artery wall atrophies, saccular enlargements - aneurysms may appear. Most often, they appear in the largest and most intensely working vessel - the aorta. In the small arteries that penetrate the muscles and internal organs, lipid deposits also form with age, and cicatricial defects of the inner membrane appear. The middle muscular membrane of the vessels undergoes significant changes.

Overstrain of the nervous system, high blood pressure, metabolic disorders in the muscle cell and a number of other reasons cause an increase in size and thickening of the muscle layer. Such changes often lead to an increase in blood pressure, together with other factors are the cause of hypertension.

In the body there is not a single organ, not a single tissue, the well-being of which would not directly depend on the state of the capillary system. The capillary network is also subject to aging, which manifests itself in two ways.

First, the number of active capillaries per unit of tissue volume is significantly reduced.

Secondly, the functions of the capillary wall, consisting of one layer of cells, are disrupted. According to some clinicians and physiologists, anatomical and functional changes in the capillary system are one of the main signs of aging in the human body and the main cause of diseases associated with aging. Changes in the lumen of the capillaries (their narrowing or expansion) lead to a slowdown in blood flow, sometimes it even stops completely. Age-related thickening of the capillary walls reduces their permeability, as a result of which the conditions for nutrition and respiration of tissues deteriorate, and metabolic products are retained and accumulated in them.

With age, significant changes occur in the heart itself. For 70 years of a person's life, the heart pumps 165 million liters of blood. Its contractile ability depends primarily on the state of myocardial cells. Such cells (cardiomyocytes) in mature and elderly people are not renewed and the number of cardiomyocytes decreases with age. Upon death, they are replaced by connective tissue. But the body tries to compensate for the loss of myocardial cells by increasing the mass (and hence the strength) of each working myocardial cell. Naturally, this process is not unlimited, and gradually the contractile ability of the heart muscle decreases.

They are also called pacemakers, i.e. cells capable of generating impulses that create a heart rhythm. The number of cells of the conducting system begins to decrease from the age of 20, and in old age their number is only 10% of the original. This process, of course, creates the preconditions for the development of heart rhythm disturbances. These are the changes that occur with the inevitable aging process of the body. We are not able to change nature, but we are able to prolong youth and health of the cardiovascular system.

Dietary supplement "Vazomax" has the following effects that slow down age-related changes in the circulatory system:

Neutralization of the damaging effects of free radicals;

Strengthening the wall and maintaining the health of the capillaries;

Reducing the severity of athero-sclerotic deposits on the inner wall of the arteries;

Maintaining the elasticity of large vessels;

Elimination of excessive muscle spasm of small arteries and arteriol.

Thus, "Vazomax" helps to maintain the health of large, medium and small arteries and the functionality of the capillary bed. Slowing down the progression of age-related changes, "Vazomax" improves the functioning of the circulatory system to maintain the life of cells and tissues, timely delivery of oxygen and nutrients and excretion of metabolic products.

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Cardiovascular system of the elderly: age-related changes

Nature has taken care of the inevitability of evolution: aging and death are embedded in our DNA. This ensures a generational change, but leads to a sad result - old age cannot be avoided. But you can slow down its onset and prevent the onset of diseases that can shorten life expectancy. This applies to all organs, but the cardiovascular system requires special attention.

In the modern world, the first signs of cardiovascular disease can appear in very young people. This is due, most often, not to the most healthy way life, with unhealthy diet, lack of physical activity, increased stress levels and bad habits. Of course, heredity also makes itself felt, but a predisposition to heart disease may not appear if provoking factors are excluded. Age-related changes will still manifest themselves sooner or later, but let it happen later.

Age-related changes in the cardiovascular system in the elderly

Over the years, irreversible processes occur in the cardiovascular system of the elderly, affecting the heart, blood vessels, and nerve fibers through which signals to organs pass. Muscle fibers can be replaced by fibrous tissue, which reduces muscle strength, negatively affects the elasticity of the vessel walls.

Small capillaries that provide oxygen delivery to the most secret corners of the body, partially die off or stick together, which leads to a deterioration in tissue nutrition. Large vessels can be narrowed due to deposits on the inner walls of lipids that form cholesterol atherosclerotic plaques.

The heart begins to contract with less force, the volume of ejection decreases. But at the same time, the size of the main pump of the body may increase slightly. The valves can undergo deformation or degenerative changes. Arrhythmias are common in older people.

Blood pressure is regulated by the nervous system, and special receptors play an important role in this process. With age, baroreceptors lose sensitivity, which makes regulation difficult and leads to an increase in pressure.

Rehabilitation of the cardiovascular system in old age

Changes in the metabolic rate in the body of an elderly person negatively affect all recovery processes, slowing down recovery. That is why the rehabilitation of the cardiovascular system in old age after illness is difficult. It is much more correct to try to avoid an illness than to deal with its consequences later.

Give up bad habits, especially nicotine addiction. Smoking not only poisons the body, but also has a detrimental effect on blood vessels.
Eat rationally and in moderation, excluding from the diet harmful products.
Maintain your weight at the proper level. Obesity increases the risk of developing not only heart disease, but also diabetes mellitus several times, and also increases the load on the joints.
Move more: walk, dance, swim, ride a bike, do yoga or aqua aerobics.

A healthy lifestyle transforms old age from a time of sad extinction into a period of life full of joy and freedom. After all, old age itself is not terrible - illness and weakness are terrible.

H The steady aging of the population of developed countries increases the proportion of cardiovascular diseases in the overall structure of morbidity, and therefore leads to an increase in the number of elderly patients in the practice of doctors of many specialties. Therefore, knowledge of the geriatric aspects of cardiology is an important element of knowledge not only of a modern cardiologist, but also of a geriatrician, family doctor and general practitioner.

Until recently, there was an opinion about the need for only symptomatic treatment of cardiovascular diseases (CVD) in the elderly and the elderly and about the insignificant effect of drug intervention on the prognosis of life at this age. Meanwhile, large clinical trials convincingly indicate that the patient's age is not an obstacle to active drug and surgical treatment of many cardiovascular diseases - coronary artery disease, arterial hypertension, stenosing atherosclerosis of the main arteries, and cardiac arrhythmias. Moreover, since the absolute risk of cardiovascular complications in the elderly is higher, the treatment of CVD in the elderly is even more effective than in young and middle-aged people.

Treatment goals for cardiovascular disease in the elderly

As in other age groups, the main goals of treatment in the elderly are to improve quality and increase life expectancy. For a physician familiar with the basics of geriatrics and clinical pharmacology in the elderly, both goals are generally achievable.

What is important to know when prescribing treatment for the elderly?

Within the framework of this article, the features of treatment in elderly patients with the most common cardiovascular diseases are considered:

Arterial hypertension, incl. isolated systolic hypertension
Heart failure

Arterial hypertension in the elderly

Arterial hypertension (AH), according to various estimates, occurs in 30-50% of people over 60 years of age. Diagnosis and treatment of this disease have a number of important features (Table 4). The elderly need to measure blood pressure (BP) especially carefully, since they often have "pseudohypertension". The reasons for this are both the rigidity of the main arteries of the extremities, and the large variability of systolic blood pressure. In addition, orthostatic reactions (due to violations of the baroreceptor apparatus) are characteristic for elderly patients, therefore, it is strongly recommended to compare blood pressure in the patient's lying position and immediately after the transition to an upright position.

Due to the high prevalence of hypertension, especially the isolated increase in systolic blood pressure among the elderly, this disease has long been considered as a kind of relatively benign age-related change, the active treatment of which could worsen well-being due to an excessive decrease in blood pressure. They also feared more, than at a young age, the number of side effects of drug therapy. Therefore, doctors resorted to lowering blood pressure in the elderly only if there were clinical symptoms (complaints) associated with high blood pressure. However, by the beginning of the 90s of the XX century, it was shown that regular long-term antihypertensive therapy significantly reduces the risk of developing major cardiovascular complications of hypertension - cerebral stroke, myocardial infarction and cardiovascular mortality. A meta-analysis of 5 randomized clinical trials, which included more than 12 thousand elderly patients (aged\u003e 60 years), showed that an active decrease in blood pressure was accompanied by a decrease in cardiovascular mortality by 23%, coronary heart disease cases - by 19%, heart failure cases - by 48%, the frequency of strokes - 34%.

A review of the main prospective randomized trials showed that in elderly patients with hypertension, drug-induced reduction in blood pressure within 3-5 years significantly reduces the incidence of heart failure by 48%.

Thus, there is no doubt today that older hypertensive patients are reaping the real benefits of lowering blood pressure. However, after a diagnosis has been made and a decision has been made to treat an elderly patient with hypertension, a number of circumstances must be taken into account.

Elderly people respond very well with blood pressure lowering to salt restriction and weight loss. Starting doses of antihypertensive drugs are half the usual starting dose. Dose titration is slower than in other patients. You should strive for a gradual decrease in blood pressure to 140/90 mm Hg. (with concomitant diabetes mellitus and renal failure, the target blood pressure is 130/80 mm Hg). It is necessary to take into account the initial level of blood pressure, the duration of hypertension, the individual tolerance of the decrease in blood pressure. The concomitant decrease in diastolic blood pressure in patients with isolated systolic hypertension is not an obstacle to the continuation of therapy. In research SHEP the average level of diastolic blood pressure in the group of treated patients was 77 mm Hg, and this corresponded to an improved prognosis.

Thiazide diuretics, β-blockers and their combinations were effective in reducing the risk of cardiovascular complications and mortality in elderly patients with hypertension, with diuretics (hydrochlorothiazide, amiloride) having an advantage over β-blockers. Recently Completed Major Study ALLHAT clearly confirmed the benefits of diuretics in the treatment of hypertension in all age groups. In the 7th Report of the US Joint National Committee on the Detection, Prevention and Treatment of Arterial Hypertension (2003), diuretics are given a leading role both in monotherapy and in combination treatment of hypertension. A clinical trial is underway HYVET with the participation of 2100 patients with arterial hypertension aged 80 years and older. Patients will be randomized to placebo and indapamide diuretic (including in combination with the ACE inhibitor perindopril). The target BP in this study was 150/80 mm Hg, the primary endpoint was stroke, and the secondary endpoint was all-cause and cardiovascular mortality.

Studies have shown the effectiveness of calcium anatagonist amlodipine (Amlovas) ... The advantage of using amlodipine in lowering blood pressure has been shown compared to another calcium antagonist, diltiazem. The duration of action of amlodipine is 24 hours, which contributes to a single dose per day and provides ease of use. In research THOMS there was a decrease in the left ventricular myocardial mass index in the group of patients taking amlodipine.

ACE inhibitors are the drugs of choice for at least two categories of elderly patients with hypertension - 1) with left ventricular dysfunction and / or heart failure; 2) with concomitant diabetes mellitus. This is based on a proven reduction in cardiovascular mortality in the first case and a delay in the development of renal failure in the second. In case of intolerance, ACE inhibitors can be replaced with angiotensin receptor antagonists.

a-adrenergic blockers (prazosin, doxazosin) are not recommended for the treatment of hypertension in the elderly due to the frequent development of orthostatic reactions. Also, in a large clinical trial ALLHAT an increase in the risk of heart failure is shown against the background of the treatment of hypertension with α-adrenergic blockers.

Heart failure in the elderly

Currently, chronic heart failure (CHF) suffers from 1-2% of the population of developed countries. Annually, chronic heart failure develops in 1% of people over 60 years old and in 10% of people over the age of 75 years.

Despite the significant progress achieved in the last decade in the development of therapeutic algorithms for the treatment of CHF using various drugs and their combinations, the specificity of treatment of elderly and elderly patients remains poorly understood. The main reason for this was the deliberate exclusion from the majority of prospective clinical studies on the treatment of CHF of people over 75 years old - primarily women (who make up more than half of all elderly people with CHF), as well as people with concomitant diseases (also, as a rule, the elderly). Therefore, before receiving data from clinical studies specially designed for the population of elderly and elderly people with CHF, one should be guided by the proven principles of treating CHF in middle-aged people - taking into account the above age characteristics of the elderly and individual contraindications. Elderly patients with CHF are prescribed ACE inhibitors, diuretics, β-blockers, spironolactone as drugs that have been shown to improve survival and quality of life. With supraventricular tachyarrhythmias against the background of CHF, digoxin is very effective. If it is necessary to treat ventricular arrhythmias against the background of CHF, preference should be given to amiodarone, since it has a minimal effect on myocardial contractility. In severe bradyarrhythmias on the background of CHF (sick sinus syndrome, intracardiac blockade), the possibility of implanting a pacemaker should be actively considered, which often significantly facilitates the possibilities of pharmacotherapy.

Timely detection and elimination / correction of concomitant diseases, often latent and low-symptomatic (exhaustion, anemia, thyroid dysfunction, liver and kidney diseases, metabolic disorders, etc.) is extremely important for the successful treatment of CHF in the elderly.

Stable coronary artery disease in the elderly

Elderly people make up the majority of patients with coronary artery disease. Almost 3/4 of deaths from coronary heart disease occur among people over 65 years of age, and almost 80% of those who die from myocardial infarction belong to this age group. At the same time, in more than 50% of cases, death of persons over 65 occurs from complications of coronary artery disease. The prevalence of ischemic heart disease (and, in particular, angina pectoris) at young and middle age is higher among men than among women, however, by the age of 70-75 years, the frequency of ischemic heart disease among men and women is comparable (25-33%). The annual mortality rate among patients in this category is 2-3%, in addition, another 2-3% of patients may develop non-fatal myocardial infarction.

Features of ischemic heart disease in old age:

Atherosclerosis of several coronary arteries at once
Stenosis of the left trunk of the coronary artery is common
Decreased left ventricular function is common
Atypical angina, painless myocardial ischemia (up to painless MI) are common.

The risk of complications during routine invasive studies in the elderly is slightly increased, therefore, old age should not serve as an obstacle to referring a patient to coronary angiographic examination.

Features of the treatment of stable coronary artery disease in the elderly

When choosing drug therapy for elderly patients, it should be remembered that the treatment of ischemic heart disease in the elderly is carried out according to the same principles as in young and middle age, but taking into account some of the features of pharmacotherapy (Table 5.6).

The effectiveness of medications prescribed for coronary artery disease, as a rule, does not change with age. Active antianginal, anitischemic, antiplatelet and lipid-lowering therapy can significantly reduce the incidence of coronary heart disease complications in the elderly. According to indications, all groups of drugs are used - nitrates, b-blockers, antiplatelet agents, statins. However, there is not enough evidence-based studies specifically devoted to the treatment of coronary artery disease in older and elderly people. At the same time, the proven benefit of a calcium channel blocker amlodipine at a dose of 5-10 mg / day in reducing the frequency of episodes of myocardial ischemia (Holter monitoring data). The decrease in the frequency of pain attacks in comparison with placebo makes the use of the drug promising in this category of patients, especially in those who suffer from hypertension. IN last years clinical studies are conducted specifically dedicated to efficacy drug treatment IHD in the elderly.

Summarized data from studies on secondary lipid-lowering prophylaxis with statins LIPID , CARE and 4S indicate that with a comparable decrease in the relative risk of cardiovascular complications among young and elderly patients, the absolute benefit of treatment with statins (simvastatin and pravastatin) is higher among the elderly. Effective treatment for 1000 elderly (aged<75 лет) пациентов в течение 6 лет предотвращает 45 смертельных случаев, 33 случая инфаркта миокарда, 32 эпизода нестабильной стенокардии, 33 процедуры реваскуляризации миокарда и 13 мозговых инсультов. Клинические испытания с участием больных старше 75 лет продолжаются. До получения результатов этих исследований вопросы профилактического назначения статинов больным с ИБС самого старшего возраста следует решать индивидуально.

In a large multicenter randomized trial PROSPER studied the effect of long-term administration of pravastatin (40 mg / day) on the course and outcomes of coronary artery disease and the incidence of strokes in elderly people (age of participants 70-82 years) with proven coronary artery disease or risk factors for its development. During 3.2 years of treatment, pravastatin reduced plasma LDL-C levels by 34% and reduced the combined risk of death from coronary heart disease and nonfatal MI by 19% (RR 0.81, 95% CI 0.69-0.94). The relative risk of strokes in the active treatment group did not significantly change (RR 1.03, 95% CI 0.81-1.31), while the total relative risk of death from coronary heart disease and stroke, as well as nonfatal MI and nonfatal stroke decreased by 15% (RR 0.85, 95% CI 0.74-0.97, p \u003d 0.0014). Mortality from coronary artery disease among those receiving pravastatin decreased by 24% (RR 0.76, 95% CI 0.58-0.99, p \u003d 0.043). The study noted the good tolerance of long-term administration of pravastatin as part of combination therapy in the elderly - there were no cases of myopathy, liver dysfunction, or statistically significant memory impairment. Among those taking statins, there was a higher detection rate (but not an increase in mortality!) Of concomitant oncological diseases (RR 1.25, 95% CI 1.04-1.51, p \u003d 0.02). The authors attribute this finding to a more thorough diagnostic examination of elderly people included in the study.

Thus, the clinical trial of PROSPER at a high methodological level has proven the effectiveness and good tolerability of long-term administration of pravastatin in elderly people with coronary artery disease, other cardiovascular diseases and cardiovascular risk factors.

Efficiency coronary artery bypass grafting and stenting operations coronary arteries in the elderly are comparable to the effectiveness of these interventions in younger patients, so age, in itself, is not an obstacle to invasive treatment. Limitations can be caused by concomitant diseases. Given the fact that the elderly are more likely to experience complications after bypass surgery, as well as symptomatic improvement, as the most common desired goal of intervention in the elderly, it is necessary to take into account all concomitant diseases during preoperative preparation and, if possible, give preference to balloon coronary angioplasty and coronary artery stenting. ...

Literature:

1. Aronow W.S. Pharmacologic therapy of lipid disorders in the elderly, Am J Geriatr Cardiol, 2002; 11 (4): 247-256

2. Brookes L. "More antihypertensive treatment trials in the elderly: PROGRESS, Syst-Eur, VALUE, HYVET" Medscape coverage of 1st Joint Meeting of the International and European Societies of Hypertension

3. Jackson G. "Stable angina in the elderly." Heart and Metabolism 2003; 10: 7-11

4. Rich M.W. Heart failure in the elderly: strategies to optimize outpatient control and reduce hospitalizations. Am J Geriatr Cardiol, 2003 12 (1): 19-27

5. Sander G.E. High blood pressure in the geriatric population: treatment consideration. Am J Geriatr Cardiol, 2002; 11; (3): 223-232

6. The Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation and Treatment of High Blood Pressure. J.A.M.A. 2003; 289: 2560-2572

7. Tresch D.D., Alla H.R. "Diagnosis and management of myocardial ischemia (angina) in the elderly patient" Am J Geriatr Cardiol, 2001 10 (6): 337-344

8. Belenkov Yu.N., Mareev V.Yu., Ageev F.T. "National guidelines for the diagnosis and treatment of chronic heart failure." Heart Failure, 2002, no. 6: 3-8

9. Lazebnik LB, Komissarenko I.A., Guseinzade M.G., Preobrazhenskaya I.N. "Beta-blockers in geriatric practice" breast cancer, 1999, volume 7 No. 16: 66-70

10. Lazebnik LB, Komissarenko I.A., Milyukova O.M. "Drug treatment of isolated systolic hypertension in the elderly" BC, 1998, vol. 6, No. 21: 25-29

11. Lazebnik L.B., Postnikova S.L. "Chronic heart failure in elderly people" BC, 1998, vol. 6, No. 21: 34-38

Abstract on the topic:

Features of CVS in the elderly.

Completed by: Mingazheva Elvira 401gr

Checked by: V.V. Evdokimov

Arterial hypertension in old age

The increase in life expectancy entails an increase in the elderly population.
The prevalence of arterial hypertension (AH) increases with age, it is observed in about 60% of older people. The level of blood pressure is a risk factor, the elimination of which significantly reduces the risk of developing cardiovascular diseases and death, the frequency of which among the elderly is much higher than among the young.
Blood pressure increases with age: SBP - up to 70-80 years, DBP - up to 50-60 years; subsequently, stabilization or even a decrease in DBP is noted. An increase in SBP in the elderly significantly increases the risk of developing cardiovascular complications such as coronary artery disease (CHD), cerebrovascular disease, heart and renal failure, as well as death from them. In accordance with the results of recent studies, pulse blood pressure (the difference between systolic and diastolic blood pressure) is considered as the most accurate predictor of cardiovascular complications in patients over 60 years of age due to the fact that it reflects pathological rigidity of the arterial walls. The most convincing results are meta-analyzes based on three studies - EWPHE, SYST-EUR and SYST-CHINA. They provided evidence that the higher the level of systolic blood pressure and the lower the level of diastolic blood pressure, that is, the higher the pulse blood pressure, the worse the prognosis for cardiovascular morbidity and mortality.
Currently, the normal values \u200b\u200bof pulse blood pressure are not clearly defined, although most studies have shown a significant increase in cardiovascular risk with pulse blood pressure above 65 mm Hg. Art.

Pathogenetic mechanisms of hypertension in old age
The following structural and functional changes in the cardiovascular system during aging should be noted.
Anatomical changes
Heart:
an increase in the cavities of the left atrium and left ventricle;
calcification of the mitral and aortic valve rings.
Vessels:
an increase in the diameter and length of the aorta;
thickening of the aortic wall.
Physiological changes
Heart:
decreased compliance of the left ventricle;
violation of diastolic filling of the left ventricle (decrease in early filling and increase in filling during atrial systole).
Vessels:
decreased elasticity;
an increase in the speed of the pulse wave;
increased SBP.

Histophysiological changes
Increase in the content of lipids, collagen, lipofuscin, amyloid in tissues.
Decrease in the number of myocytes with an increase in their size.
Decrease in the rate of relaxation of myocytes.
Decreased sensitivity of β-adrenergic receptors.
Increasing the duration of myocyte contraction.

Features of examination of elderly patients with hypertension
In addition to routine diagnostics, which is performed in all patients with hypertension, patients over 60 years of age should be examined for pseudohypertension, white coat hypertension, orthostatic hypotension, and secondary arterial hypertension.
Much attention should be paid to the correct measurement of blood pressure. It should be done in a seated position after a 5-10 minute rest. Blood pressure is defined as the average of two or more measurements.
Sometimes when measuring blood pressure in older people, you can get false results due to the "auscultatory dip" - the absence of tones for a certain period after the I tone appeared, which characterizes SBP. This can lead to a decrease in systolic blood pressure by 40-50 mm Hg. Art. To avoid errors and to register the tone that appears before the "auscultatory dip", it is recommended to inflate the cuff to 250 mm Hg. Art. and slowly release the air. Hypertension is diagnosed if SBP\u003e 140 mm Hg. Art. or DBP\u003e 90 mm Hg. Art. during several examinations.
Hypertension in the elderly is often accompanied by an increase in the rigidity of the arterial wall due to its thickening and calcification. In some cases, this contributes to an overestimation of blood pressure values, since the cuff cannot compress the rigid artery. In such a situation, the blood pressure level when measured with a cuff (indirect method) can be 10-50 mm Hg. Art. higher than using an intra-arterial catheter (direct method). This phenomenon is called pseudohypertension. Osler's test sometimes helps to diagnose it: determination of pulsation on a. radialis or a. brachialis distal to the cuff after air injection approximately to the patient's SBP level. If a pulse is palpable despite severe compression of the brachial artery, this indicates the presence of pseudohypertension. It should be suspected in cases where there are no other signs of target organ damage against the background of high blood pressure. If an elderly person with pseudohypertension is prescribed antihypertensive therapy, he may have clinical signs of an excessive decrease in blood pressure, although there is no hypotension when measuring it.
High variability of blood pressure is another sign of increased rigidity of large arteries.

Clinical manifestations of increased blood pressure variability can be:
orthostatic decrease in blood pressure;
decrease in blood pressure after eating;
increased antihypertensive response to antihypertensive therapy;
increased hypertensive response to isometric and other types of stress;
"White coat hypertension."
Patients with complaints of severe changes in blood pressure, dizziness and fainting in history, or patients with high blood pressure at the doctor's appointment and no signs of target organ damage are shown outpatient daily monitoring of blood pressure or blood pressure measurement at home 4-5 times a day. In addition, in elderly patients with hypertension, disturbances in the circadian rhythm of blood pressure are often observed, which require identification and correction, since they can cause cardiovascular complications.
To diagnose orthostatic hypotension, all patients over 50 years of age are shown to measure blood pressure in the supine position, and after 1 and 5 minutes - while standing. The normal BP response to the transition from a prone to a standing position is a slight increase in DBP and a decrease in SBP. Orthostatic hypotension occurs when SBP decreases by more than 20 mm Hg. Art. or DBP rises by more than 10 mm Hg. Art. The causes of orthostatic hypotension, as mentioned above, are a decrease in BCC, dysfunction of baroreceptors, impaired activity of the autonomic nervous system, as well as the use of antihypertensive drugs with a pronounced vasodilating effect (a-blockers and combined a- and b-blockers). Diuretics, nitrates, tricyclic antidepressants, sedatives, and levodopa can also worsen orthostatic hypotension.
To reduce the severity of orthostatic hypotension, it is recommended to adhere to the following rules:
lie on a high pillow or raise the head of the bed;
rise from a prone position slowly;
before moving around, if possible, perform isometric exercises, for example, squeeze a rubber ball in your hand and drink at least a glass of liquid;
take food in small portions.
Another important point in the examination of elderly patients with hypertension, this is the exclusion of secondary hypertension. The most common causes of secondary hypertension in elderly patients are renal failure and renovascular hypertension. The latter, as a possible cause of an increase in blood pressure, is recorded in 6.5% of hypertensive patients aged 60-69 years and in less than 2% of patients 18-39 years old.

Treatment of the elderly with arterial hypertension
The goal of treating elderly patients with hypertension is to lower blood pressure below 140/90 mm Hg. Art.
Non-drug therapy is an obligatory component of the treatment of elderly patients with hypertension. In patients with mild hypertension, it can lead to normalization of blood pressure, in patients with more severe hypertension, it can reduce the amount of antihypertensive drugs taken and their dosage. Non-drug treatment consists of lifestyle changes.
A decrease in body weight with its excess and obesity contributes to a decrease in blood pressure, improves the metabolic profile in these patients.
Reducing table salt intake to 100 mEq Na, or 6 g table salt per day, can have a significant effect on blood pressure in the elderly.In general, results of controlled studies show a slight but stable decrease in blood pressure in response to limiting salt intake to 4-6 g / day
An increase in physical activity (35-40 minutes per day of dynamic loads, for example, brisk walking) also has an antihypertensive effect and has a number of other positive effects, in particular metabolic.
Reducing alcohol consumption per day to 30 ml of pure ethanol (maximum 60 ml of vodka, 300 ml of wine or 720 ml of beer) for men and 15 ml for women and men with low body weight also helps to reduce blood pressure.
The inclusion in the diet of foods high in potassium (approximately 90 mmol / day). The effect of potassium on blood pressure has not been conclusively proven, however, given its effect on the prevention of strokes and the course of arrhythmias, elderly patients with hypertension are advised to consume vegetables and fruits rich in this element.
The enrichment of the diet with calcium and magnesium has a beneficial effect on the general condition of the body, and calcium also slows down the progression of osteoporosis.
Stopping smoking and reducing the proportion of saturated fat and cholesterol in the diet can improve cardiovascular health.
It must be remembered that one of the reasons for an increase in blood pressure in old age may be the treatment of concomitant diseases with nonsteroidal anti-inflammatory drugs, therefore, their use should be reduced.

Drug therapy
In the case when non-drug treatment does not allow to normalize blood pressure, it is necessary to consider the appointment of drug antihypertensive therapy.
Patients with SBP above 140 mm Hg. Art. and concomitant diabetes mellitus, angina pectoris, heart, renal failure or left ventricular hypertrophy, treatment of hypertension should be started with pharmacotherapy against the background of lifestyle changes.
The regimen for taking medications should be simple and understandable for the patient, treatment should be started with low doses (half that in young people), gradually increasing them until the target blood pressure is reached - 140/90 mm Hg. Art. This approach helps prevent orthostatic and postprandial (postprandial) hypotension.
A forced decrease in blood pressure can worsen cerebral and coronary blood flow against the background of obliterating atherosclerotic vascular lesions.
Pharmacotherapy used in elderly patients with hypertension does not differ from that prescribed for young patients. Long-acting diuretics and dihydropyridine calcium antagonists are drugs that are effective in preventing stroke and major cardiovascular complications.
Thus, the algorithm for the management of elderly patients with hypertension is as follows:
establishing a diagnosis (excluding the secondary nature of hypertension, "white coat hypertension" and pseudohypertension);
risk assessment taking into account the presence of concomitant diseases;
non-drug treatment;
drug therapy.
However, it must be remembered that only an individual approach to the examination and treatment of elderly patients can improve their quality of life and prognosis in a particular patient.

Coronary heart disease

Coronary artery disease is damage to the myocardium caused by impaired blood flow in the coronary arteries. That is why the term coronary heart disease is often used in medical practice.

Usually, people with coronary artery disease develop symptoms after age 50. They occur only with physical exertion. Typical manifestations of the disease are:

pain in the middle of the chest (angina);

feeling short of breath and shortness of breath;

circulatory arrest due to too frequent heart contractions (300 or more per minute). This is often the first and last manifestation of the disease.

Some patients with coronary artery disease do not experience any pain or feeling short of breath even during myocardial infarction.

The more risk factors a person has, the more likely the disease is. The influence of most risk factors can be reduced, thereby preventing the development of the disease and the occurrence of its complications. These risk factors include smoking, high cholesterol and high blood pressure, and diabetes.

Diagnostic methods: registration of an electrocardiogram at rest and with a stepwise increase in physical activity (stress test), chest x-ray, biochemical blood test (with determination of cholesterol and blood glucose levels). If there is severe damage to the coronary arteries requiring surgery, then coronary angiography. Depending on the condition of the coronary arteries and the number of affected vessels, as a treatment, in addition to drugs angioplasty, or coronary artery bypass grafting. If you go to the doctor on time, they will prescribe medications that help reduce the influence of risk factors, improve the quality of life and prevent the development of myocardial infarction and other complications:

statins to lower cholesterol levels;
beta-blockers and angiotensin-converting enzyme inhibitors to lower blood pressure;
aspirin to prevent blood clots;
nitrates to relieve pain relief from an angina attack
do not smoke. It's the most important. Non-smokers have a significantly lower risk of myocardial infarction and death than smokers;
eat foods low in cholesterol;
exercise regularly, every day for 30 minutes (walking at an average pace);
reduce your stress levels.

Atherosclerosis

Atherosclerosis (from the Greek athera - kashitsa and sclerosis), a chronic disease characterized by compaction and loss of elasticity of the walls of the arteries, narrowing of their lumen, followed by impaired blood supply to the organs; usually the entire arterial system of the body is affected (albeit unevenly). A. older people are sick more often. The external manifestations of the disease are usually preceded by many years of asymptomatic period; to some extent, atherosclerotic changes are present in many young people. Men are 3-5 times more likely to suffer from A. than women. In the development of the disease, hereditary predisposition is important, as well as individual characteristics organism. Contribute to the development of A. diabetes mellitus, obesity, gout, cholelithiasis, and others. Eating with an excessive amount of animal fat plays an essential role as a factor predisposing to A., but not as the root cause of A. Low physical activity is well known in A.'s origin. An important reason should be considered psycho-emotional overstrain, traumatizing the nervous system, the influence of the intense pace of life, noise, some specific working conditions, etc.

The mechanism of development of the disease consists in a violation of the metabolism of lipids (fat-like substances), especially cholesterol, in changes in the structure and function of the vascular wall, the state of the coagulation and anti-coagulation systems of the blood. With a violation of cholesterol metabolism, the content of cholesterol in the blood rises, which over time becomes an important (albeit optional) link in the development of the disease. Apparently, with A., not only the degree of utilization and excretion of excess food cholesterol is reduced, but also its synthesis in the body is increased. Metabolic disorders are associated with a disorder of its regulation - by the nervous and endocrine systems.

With A., atherosclerotic plaques form in the vascular wall - more or less dense thickening of the inner lining of the artery. Initially, the protein substance of the inner lining of the artery swells. In the future, its permeability increases: cholesterol penetrates the vessel wall. The accumulation of cholesterol in the walls of the arteries causes secondary changes in the vessels, expressed in the proliferation of connective tissue. In the future, atherosclerotic plaques undergo a number of changes: they can disintegrate with the formation of a gruel-like mass (hence the name A.), lime is deposited in them (calcification) or a translucent homogeneous substance (hyaline) is formed. The process is progressive. The lumens of the vessels are narrowed. Due to the circular arrangement of plaques, the vessels lose their ability to expand, which, in turn, disrupts the regulation of the blood supply to organs during intensive work. Irregularities inside the vessels in A. promote the formation of blood clots, blood clots, which aggravate the violation of blood circulation up to its complete cessation. The development of blood clots is also facilitated by a decrease in the intensity of anti-clotting processes observed in A. Some researchers associate the onset of A. development with impaired blood coagulation, the accumulation of thrombotic masses in the vessel walls, followed by their obesity, loss of cholesterol, and a connective tissue reaction.

With the predominance of atherosclerotic changes in the vessels of the heart, brain, kidneys, lower extremities, in the organ experiencing a lack of blood supply as a result of A., there are disorders that determine the clinical picture of the disease. A. cardiac vessels are expressed by coronary insufficiency or myocardial infarction. A. cerebral vessels leads to mental disorders, and with pronounced degrees - to all kinds of paralysis. A. renal arteries are usually manifested by persistent hypertension. A. vessels of the legs can be the cause of intermittent claudication (see Obliterating endarteritis), the development of ulcers, gangrene, etc.

Treatment and prevention of A. are aimed at regulating general and cholesterol metabolism. At the same time, measures to normalize working and living conditions are important (observance of the work and rest schedule, physical education, etc.). Food should not be excessive, especially with regard to animal fats and carbohydrates. The diet includes foods containing vitamins, vegetable oils. Of the medicinal drugs used are some vitamins, hormonal agents, drugs that inhibit cholesterol synthesis, promote its excretion, and other drugs that prevent blood clotting - anticoagulants, as well as vasodilator drugs. Treatment is carried out on a strictly individual basis with mandatory medical supervision.

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