Blood pressure regulation during the aging process: the end of the ‘hypertension era’?

The elderly blood pressure paradigm reflects all of the demographic, technological and therapeutic changes over the past 20-30 years that make it now possible to propose a more integrative approach of 'hypertension'. The aim of the present review was to address what does measured blood pressure really mean and what are its determinants during the aging process. We show that standard blood pressure measurements are not adequate or even misleading for the evaluation of cardiovascular risk especially in the elderly patients and that there is a necessity of a transition to a new approach in determining the arterial risk. Direct arterial measurements including analysis of central and peripheral arterial waveforms and assessment of pulse wave velocity can be reliable and easily performed measurements as an alternative to blood pressure-Korotkoff approach. For these measurements, there are currently sufficient clinical data showing their association with cardiovascular risk. There is also the emergence of reference values and beneficial elements of regression by treatment. This new approach as well as recent knowledge on vascular hemodynamics and biology, represent the swan song for the hypertension concept as defined by blood pressure values.