Epidemiology of stroke. Importance of preventive pharmacological strategies in elderly patients and associated costs.
Stroke is a major cause of death and disability in developed countries. The incidence of stroke increases exponentially with age, yet, traditionally, many medical practitioners have been reluctant to treat hypertension in older patients. Since 1991, the results of 3 major trials--the British Medical Research Council (MRC) trial of treatment in older adults, the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) and the Systolic Hypertension in the Elderly Program (SHEP)--have conclusively established the benefits of treating older patients (> 60 years) with both diastolic and isolated systolic hypertension. International guidelines for the management of hypertension--including the Fifth Report of the Joint National Committee, the 1993 report of the World Health Organization and the International Society of Hypertension and the second report of the British Hypertension Society Working Party--have all been modified to reflect the emerging evidence concerning the benefits of treating older patients. Cost-effectiveness data are similarly in accord with giving high priority to the treatment of older individuals with hypertension.
Kawachi
I
I
Harvard School of Public Health, Boston, Massachusetts.
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology* / Q000502:physiology; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D017408:Guidelines as Topic; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007391:International Cooperation; D008875:Middle Aged; D009520:New Zealand; D011788:Quality of Life; D012307:Risk Factors; D006113:United Kingdom; D014944:World Health Organization
D000959:Antihypertensive Agents