Management of hypertension and cerebrovascular disease in the elderly.
Cardiovascular disease and stroke disproportionately affect the elderly. The risk for stroke and transient ischemic attack increases exponentially with age. Blood pressure is a potent modifiable target for reducing the risk for stroke in the elderly. In elderly patients with isolated systolic hypertension and those with intracranial atherosclerotic disease, blood pressure lowering has consistently been shown to be well tolerated and effective in reducing the risk for stroke and its complications. Evidence suggests that ambulatory blood pressure monitoring may provide a more sensitive means of detecting patients at risk and monitoring therapeutic effect. Agents that modify the renin-angiotensin system, particularly angiotensin receptor blockers, may confer additional benefit in stroke protection beyond blood pressure lowering. Several clinical trials currently in progress promise to provide guidance regarding the optimal choice of agent and degree of blood pressure lowering for prevention of stroke and cognitive decline in elderly patients.
Pedelty
Laura
L
Department of Neurology, University of Illinois at Chicago Circle, Chicago, Illinois 60612, USA. pedelty@uic.edu
Gorelick
Philip B
PB
D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015994:Incidence; D011379:Prognosis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents