STROKE AND HYPERTENSION AND ITS PREVENTION

Systolic and diastolic hypertension in both men and women is a well-established risk factor for the development of ischemic and hemorrhagic stroke. Antihypertensive treatment decreases the risk, but questions remain as to the precise level of hypertension to be treated, whether the effects of antihypertensive treatment are blunted with increasing age, and the best type of antihypertensive drug or combination of drugs to be used. Further questions remain concerning the incidence of pseudohypertension and the potentially harmful effects of its treatment on the brain, and the possibility that fluctuations in blood pressure may be worse than elevation alone. A pragmatic approach would be to treat hypertension with vigor in the young, with caution in the mature, and with reluctance in the old.