Hypertension and stroke:: the need for improved prevention strategies.

It is well demonstrated that the antihypertensive treatment is effective, particularly for the primary prevention of stroke. However, benefits of treatment are rather small in certain groups of patients. The explicit assessment of absolute cardiovascular risks and likely treatment benefits in patients with hypertension can usefully guide treatment decisions and provide a more rational basis for initiating therapy than blood pressure levels alone. This approach highlights the generally greater cardiovascular risk and potential treatment benefits in older compared with younger hypertensive patients. Some specific questions remain still unanswered. Evidence is accumulating concerning protective effect of antihypertensive treatment against dementia. Trials are in progress to investigate the effect of treatment on stroke incidence in hypertensive patients over the age of 80 years. Finally, despite the worldwide use of calcium antagonists and converting enzyme inhibitors, solid evidence of their safety and efficacy compared with the references drugs (beta-blockers and diuretics) is still lacking.