Haemodynamics in hypertension

The haemodynamic changes that occur during the development of established essential hypertension can be detected only by longitudinal studies. Several long-term studies thus indicate that the circulation in essential hypertension shifts from a ‘high-output, normal resistance' state in young age toward a ‘low-output, high-resistance’ state in old age. However, this pattern is not a uniform one, and essential hypertension may also start by an increase in peripheral resistance without a prior phase of an elevated cardiac output. The reasons for these different haemodynamic patterns are not yet understood. Sympathetic overactivity may, at least in part, be responsible for the haemodynamic changes seen in the starting phase of essential hypertension.

The haemodynamic characteristics in the different developmental stages of essential hypertension may vary considerably and are also influenced by ageing. Therefore, the proper use of anti-hypertensive drug treatment should be directed individually according to the underlying haemodynamic disturbances.