Reducing the risk of stroke in elderly patients with hypertension: a critical review of the efficacy of antihypertensive drugs.

The risk of ischaemic or haemorrhagic stroke is increased in patients with hypertension, with a linear relationship between elevation of blood pressure and stroke risk being seen even in normotensive individuals. In elderly subjects it has been shown that systolic blood pressure (SBP) elevation in particular is the most important risk predictor for stroke. This is also the rationale for treating elevated SBP in the elderly. Several clinical trials have repeatedly shown the benefits of blood pressure control for prevention of stroke and also for dementia, both of the multi-infarct and Alzheimer subtype. Remaining research questions involve the proper and evidence-based choice of drug treatment in the elderly hypertensive patient. In spite of the introduction of many newer antihypertensive drugs, use of thiazide diuretics is still one of the best treatment choices, as this class of drugs is well proven and cost effective. Another question concerns when and how to treat patients >80 years of age. An ongoing randomised clinical trial, the Hypertension in the Very Elderly trial, is currently trying to evaluate risks and benefits of antihypertensive treatment in this age category.