[Cerebral complications of hypertension in the elderly].
OBJECTIVE
This review focuses on cerebral complications of hypertension, which include stroke, impairment of cognitive function, dementia, and possibly depression and anxiety. These conditions are major causes of morbidity and mortality in the elderly.


BACKGROUND
Not only elevated diastolic blood pressure, but also isolated systolic hypertension and elevated pulse pressure play an important role in the development of brain complications. Randomised placebo-controlled trials have provided evidence that reduction of hypertension decreases safely and effectively morbidity and mortality rates in the elderly. The new classes of drugs, in particular calcium-channels blockers and angiotensin-converting enzyme inhibitors, have been shown to be as effective as the originally used diuretics and beta-blockers.


CONCLUSIONS
Several trials are currently in progress and should provide more information on the benefit of antihypertensive treatment in very elderly persons (Hypertension in the Very Elderly Trial, HYVET) and secondary prevention of stroke (PROGRESS). The importance of assessing new dosages of the presently used antihypertensive drugs as well as the benefit of new classes of drugs is emphasised. Further trials specifically focusing on the prevention of dementia by antihypertensive drugs are needed to confirm the results of the Syst-Eur Vascular Dementia Project. The benefit of calcium antagonists in the prevention of dementia in elderly hypertensive patients should be assessed in the Dementia Prevention in Hypertension trial (DEPHY).
Rigaud
A S
AS
Service de gérontologie, hôpital Broca, CHU Cochin-Port-Royal, 54-56, rue Pascal, 75013 Paris, France. anne-sophie.rigaud@brc.ap-hop-paris.fr
Hanon
O
O
Bouchacourt
P
P
Forette
F
F
D000368:Aged; D000375:Aging; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000209:etiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003072:Cognition Disorders / Q000209:etiology*; D003704:Dementia / Q000209:etiology* / Q000517:prevention & control; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D009017:Morbidity; D020521:Stroke / Q000209:etiology*
D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers