Screening for hypertension-mediated organ damage and aetiology:still of value after 65 years of age?

BACKGROUND Secondary forms and hypertension-mediated organ damage(HMOD) may differ between younger and older hypertensive patients.The aim of the present study was to explore the specificity of HMOD and secondary forms in patients≥ 65 years in comparison to younger ones in a contemporary cohort.METHODS We analysed 938 patients recruited between 2004 and 2014(Cardiology department,Croix-Rousse Hospital,Lyon)who had at baseline HMOD and secondary forms screening among them 190 were≥ 65 years.RESULTS The mean(2.1±0.8 vs.1.2±0.9,P <0.001) and frequency of HMOD(96.3% vs.72.9%,P <0.001) was higher in patients≥ 65 years than younger ones.Carotid femoral pulse wave velocity> 10 m/s was the most frequent HMOD in patients≥ 65 years(90.1%),while echocardiographic left ventricular hypertrophy was the most common in the younger patients(45.0%).Among ECG left ventricular indexes,only R wave in aVL lead was significantly more frequently observed in patients≥ 65 years(32.6%) than in younger ones(19.0%,P <0.001).The frequency of secondary hypertension was not significantly different between younger and older patients(respectively;30.5% vs.27.8%,P=0.487).The most frequent aetiology was primary aldosteronism regardless of age,followed by renovascular hypertension(6.3% vs.3.3%,P=0.038).Among older patients,3.2% were treated with adrenalectomy and 6.3% with percutaneous transluminal renal angioplasty.CONCLUSION Extensive screening of HMOD in older patients may be questionable as nearly all patients had one;aetiology must however be explored as a third of older patients had a secondary form.