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.