Hypertensive disease in the elderly: Predictors of clinical evolution in a follow-up study

Aims.– Hypertension is the first etiological factor of cerebrovascular disease in the elderly. Aims of the study: – to assess at the follow-up the rates of mortality, morbidity, disability, cognitive deficits; – to identify the major predictors of clinical outcomes. Materials and methods.– Sixty-six patients were recruited in a follow-up study of 2.5 years, (inclusion criteria: age > 60 years, hypertension; MMSE > 15/30; exclusion criteria: high comorbidity index, diabetes, psychiatric disease, severe sensorial impairments), and they were matched with a sample of InChianty Longitudinal Study. Results.– Mortality: no significant differences between expected and observed data (vascularity index (VI) in neuroimaging: main predictor of mortality). Comorbidities: significant reduction of the classes with lower comorbidity, paralleled by an increase of the higher levels of comorbidity. Disability: same trend of comorbidity, namely the significant shifting toward the lowest of the three levels of competence considered; an high VI was a predictor of functional decline as well as the level of cognitive impairment, of arterial stiffness and BMI. Cognitive performance: trend to decline of the overall performance, in both the “bedside” MMSE and the most complex CAMCOG; only long-term memory showed a statistically significant impairment. VI, ApoE and hypercholesterolemia, were the strongest predictors of worsening of cognitive performance. Conclusions.– Hypertensive disease in the elderly could be the source of a significant worsening of the considered outcomes. It is remarkable the reduction of competence in daily activities, explained by the convergence of the condition of frailty and difficulties of adequate response of the health-care system.