• Maximal heart rate with exercise decreases with age. “A frequently used formula for predicting maximal heart rate is 220 minus age, with a correction factor of 0.85 often applied for females, who have a lower peak heart rate and a more gradual decline.”
  • Myocardial collagen increases with age.
  • Myocardial mass increases with age.
  • Ventricular compliance decreases with age. The increase in collagen may play a  role in decreasing LV compliance.
  • Resting heart rate decreases with aging.
  • The maximal exercising heart rate also decreases with aging. Tachycardia at rest may suggest a pathologic state.
  • Cardiac output decreases with age
  • Peripheral resistance increases with age,
  • Intravascular volume decreases with age,
  • Renal blood flow decreases with age
  • Pulse pressure increases – elderly patients have a Wider Pulse Pressure.
  • “Systolic blood pressure rises gradually throughout adult life, whereas diastolic blood pressure peaks and plateaus in late middle age, and declines slightly thereafter. Diastolic hypertension occurs in <10% of all patients with hypertension after age 70.”

 

 

“Pulse pressure is the difference between systolic blood pressure and diastolic blood pressure and is a measure of the degree of age-related vascular stiffness and is a risk factor for coronary artery disease events. With increasing age the strongest predictor of coronary artery disease gradually shifts from diastolic blood pressure to systolic blood pressure, and then to pulse pressure.” ABFM

 

Further Reading / References

Circulation. 2011 May 31;123(21):2434-506. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. https://www.ncbi.nlm.nih.gov/pubmed/21518977

Cleve Clin J Med 2012;79(10):694-704. Hypertension in the elderly: Some practical considerations.

Western Journal of Medicine. 1981;135(6):434-440.  Age-Related Physiological Changes and Their Clinical Significance. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273316/

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