Overenthusiastic stroke risk factor modification in the over-80s: are we being disingenuous to ourselves, and to our oldest patients?

Statins and antihypertensive therapy are widely used in our oldest patients (ie, those aged over 80 years). The epidemiology suggests that, by this age, hypertension is not an attributable risk factor for stroke, and hypercholesterolaemia has little effect on stroke risk overall. The largest trials of antihypertensive therapy and statins in this age group show at best a marginal clinical reduction in stroke and very modest clinical reductions in other cardiovascular end points. Older patients have very diverse views on the relative importance of stroke and death as end points, and these differ from physicians' views. Informed consent principles (full relevant information in an accessible form, and autonomy of decision-making) suggest that these medications are greatly over-prescribed in the healthy elderly and largely irrelevant in the frail elderly, but require that the patient should be actively involved in the process.