ARTERIAL HYPERTENSION IN THE ELDERLY AND THE VERY OLD: PATHOPHYSIOLOGY, CLINICAL PHENOTYPES, AND PROGNOSTIC IMPLICATIONS

Abstract

Arterial hypertension represents one of the most significant medical and social challenges in the context of global population aging. Advancing age is associated with a sharp increase in hypertension prevalence, substantial changes in its clinical profile, and an amplified contribution to cardiovascular, cerebrovascular, and cognitive morbidity. This review analyzes age-related blood pressure dynamics, the pathophysiological mechanisms underlying hypertension in elderly and very old individuals, and its atypical clinical phenotypes, including isolated systolic hypertension, pseudohypertension, orthostatic, office, and masked hypertension. Particular emphasis is placed on the role of arterial stiffness, impaired baroreflex function, and circadian blood pressure dysregulation. The prognostic implications of hypertension and hypotensive states with regard to stroke, heart failure, dementia, and mortality are discussed. The review highlights the necessity of an individualized diagnostic and risk stratification strategy in older patient populations.