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Sergio Castellani, Nadia Boni, Ilaria Carobbi, Gian Franco Gensini, Giulio Masotti, P-84: The cerebral pressure autoregulation is impaired in the elderly with isolated systolic hypertension, American Journal of Hypertension, Volume 14, Issue S1, April 2001, Page 57A, https://doi.org/10.1016/S0895-7061(01)01595-3
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Abstract
The aim of this study was to evaluate the autoregulation capacity of the middle cerebral arteries in response to a pressor stimulus in the elderly with isolated systolic hypertension (ISH). A 2 minute cold pressor test (CPT) was used to increase arterial blood pressure by adrenergic stimulation in 10 patients with ISH (60-78 years 69); 10 elderly normotensives (60-69 years mean 64,5) and 10 young normotensives (17-30 years mean 23,5). Cerebral hemodynamics was studied with transcranial Doppler by continuous monitoring of the mean velocity in the middle cerebral arteries (MCA Vmean). Blood pressure (BP) (Finapres) and CO2 (capnograph) were simultaneously recorded. BP increased in all subjects during CPT (+22 mmHg, p<0.001 in the young, +14 mmHg, p<0.001 in the elderly normotensives, +15 mmHg, p<0.001 vs. baseline in hypertensives) and in the elderly also during the recovery period (p<0.01 vs. baseline in elderly normotensives; p<0.05 in elderly hypertensives). pCO2 did not change. MCA Vmean increased significantly in hypertensives (+13.8% vs. baseline p<0.001 in the right and +15,7% vs. baseline p<0.001 in the left MCA while it did not change in the other groups. In conclusion the steep rise in MCA Vmean shows a defect of cerebral pressure autoregulation in the elderly with ISH even in front of moderate blood pressure increases. Given the greater blood pressure variability in elderly hypertensives, this abnormality may lead to a cerebral damage and explain the greater incidence of cerebrovascular events in elderly patients with ISH.
