Hypertension-Related Stroke Prevention in the Elderly

Hypertension is a major risk factor for cardiovascular events, including ischemic stroke and hemorrhagic stroke. Reduction of blood pressure by lifestyle measures and antihypertensive drug therapy reduces stroke in elderly men and women. The use of diuretics, beta blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers causes a similar reduction in reducing coronary events and stroke for a given reduction in blood pressure. The American College of Cardiology Foundation/American Heart Association 2011 expert consensus document on hypertension in the elderly recommended that the blood pressure should be reduced to less than 140/90 mm Hg in adults younger than 80 years at high risk for cardiovascular events. On the basis of data from the Hypertension in the Very Elderly trial, these guidelines recommended that the systolic blood pressure should be reduced to 140 to 145 mm Hg if tolerated in adults aged 80 years and older. The 2013 European Society of Hypertension guidelines recommended that reducing blood pressure to less than 130/80 mm Hg in adults at high risk for cardiovascular events was unsupported by prospective trial data. The systolic blood pressure should be reduced to less than 140 mm Hg in these adults and to between 140 to 150 mm Hg in adults aged 80 years and older.