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Hypertension-Related Stroke Prevention in the Elderly

  • Hypertension and the Brain (M Banach and A Zanchetti, Section Editors)
  • Published:
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Abstract

Hypertension is a major risk factor for cardiovascular events, including ischemic stroke and hemorrhagic stroke. Reduction of blood pressure by lifestyle measures and antihypertensive drug therapy reduces stroke in elderly men and women. The use of diuretics, beta blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers causes a similar reduction in reducing coronary events and stroke for a given reduction in blood pressure. The American College of Cardiology Foundation/American Heart Association 2011 expert consensus document on hypertension in the elderly recommended that the blood pressure should be reduced to less than 140/90 mm Hg in adults younger than 80 years at high risk for cardiovascular events. On the basis of data from the Hypertension in the Very Elderly trial, these guidelines recommended that the systolic blood pressure should be reduced to 140 to 145 mm Hg if tolerated in adults aged 80 years and older. The 2013 European Society of Hypertension guidelines recommended that reducing blood pressure to less than 130/80 mm Hg in adults at high risk for cardiovascular events was unsupported by prospective trial data. The systolic blood pressure should be reduced to less than 140 mm Hg in these adults and to between 140 to 150 mm Hg in adults aged 80 years and older.

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References

Recently published papers of particular interest have been highlighted as: •• Of major importance

  1. Kannel WB. Hypertension in the elderly: Epidemiologic appraisal from the Framingham study. Cardiol in Elderly. 1993;1:359–63.

    Google Scholar 

  2. Garland C, Barrett-Connor E, Suarez L, Criqui MH. Isolated systolic hypertension and mortality after age 60 years. Am J Epidemiol. 1983;118:365–76.

    PubMed  CAS  Google Scholar 

  3. Aronow WS, Ahn C, Gutstein H. Risk factors for new atherothrombotic brain infarction in 664 older men and 1,488 older women. Am J Cardiol. 1996;77:1381–3.

    Article  PubMed  CAS  Google Scholar 

  4. Aronow WS, Ahn C, Kronzon I, Koenigsberg M. Congestive heart failure, coronary events and atherothrombotic brain infarction in elderly blacks and whites with systemic hypertension and with and without echocardiographic and electrocardiographic evidence of left ventricular hypertrophy. Am J Cardiol. 1991;67:295–9.

    Article  PubMed  CAS  Google Scholar 

  5. •• Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: A report of the american college of cardiology foundation task force on clinical expert consensus documents. Developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Coll Cardiol. 2011;57:2037–114. This paper is the American College of Cardiology Foundation/American Heart Association consensus document on hypertension in the elderly.

    Article  PubMed  Google Scholar 

  6. Amery A, Birkenhager W, Brixko P, et al. Mortality and morbidity results from the European working party on high blood pressure in the elderly trial. Lancet. 1985;1:1349–54.

    Article  PubMed  CAS  Google Scholar 

  7. Coope J, Warrender TS. Randomised trial of treatment of hypertension in elderly patients in primary care. BMJ. 1986;293:1145–51.

    Article  PubMed  CAS  Google Scholar 

  8. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the systolic hypertension in the elderly program (SHEP). JAMA. 1991;265:3255–64.

    Article  Google Scholar 

  9. Perry Jr HM, Davis BR, Price TR, et al. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke. The systolic hypertension in the elderly program (SHEP). JAMA. 2000;284:465–71.

    Article  PubMed  Google Scholar 

  10. Dahlof B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish trial in Old patients with hypertension (STOP hypertension). Lancet. 1991;338:1281–5.

    Article  PubMed  CAS  Google Scholar 

  11. MRC Working Party. Medical research council trial of treatment of hypertension in older adults: Principal results. BMJ. 1992;304:405–12.

    Article  Google Scholar 

  12. Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet. 1997;350:757–64.

    Article  PubMed  CAS  Google Scholar 

  13. Staessen JA, Thijs L, Gasowski J, et al. Treatment of isolated systolic hypertension in the elderly: Further evidence from the systolic hypertension in Europe (syst-Eur) trial. Am J Cardiol. 1998;82:20R–2R.

    Article  PubMed  CAS  Google Scholar 

  14. Liu L, Wang JG, Gong L, et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens. 1998;16:1823–9.

    Article  PubMed  CAS  Google Scholar 

  15. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–98.

    Article  PubMed  CAS  Google Scholar 

  16. Miura K, Nakagawa H, Ohashi Y, et al. Four blood pressure indexes and the risk of stroke and myocardial infarction in Japanese men and women. A meta-analysis of 16 cohort studies. Circulation. 2009;119:1892–8.

    Article  PubMed  Google Scholar 

  17. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics-2009 update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation. 2009;119:e21–e181.

    Article  PubMed  Google Scholar 

  18. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report. JAMA. 2003;289:2560–72.

    Article  PubMed  CAS  Google Scholar 

  19. Spence JD. Nutritional and metabolic aspects of stroke prevention. Adv Neurol. 2003;92:173–8.

    PubMed  Google Scholar 

  20. Aronow WS. Treatment of systemic hypertension. Am J Cadiovasc Dis. 2012;2:160–70.

    Google Scholar 

  21. Webster JL, Dunford EK, Hawkes C, Neal BC. Salt reduction initiatives around the world. J Hypertens. 2011;29:1043–50.

    Article  PubMed  CAS  Google Scholar 

  22. Frohlich ED, Susic D. Sodium and its multiorgan targets. Circulation. 2011;124:1882–5.

    Article  PubMed  Google Scholar 

  23. Whelton PK. Urinary sodium and cardiovascular disease risk: Informing guidelines for sodium consumption. JAMA. 2011;306:2262–4.

    Article  PubMed  CAS  Google Scholar 

  24. Gueyffier F, Boutitie, Boissel J-P. Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. Ann Intern Med. 1997;126:761–7.

    Article  PubMed  CAS  Google Scholar 

  25. Aronow WS, Frishman WH. Treatment of hypertension and prevention of ischemic stroke. Curr Cardiol reports. 2004;6:124–9.

    Article  Google Scholar 

  26. Progress Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358:1033–41.

    Article  Google Scholar 

  27. Hansson L, Lindholm LH, Ekbom T, et al. Randomised trial of old and new antihypertensive drugs in elderly patients: Cardiovascular mortality and morbidity the Swedish trial in Old patients with hypertension-2 study. Lancet. 1999;354:1751–6.

    Article  PubMed  CAS  Google Scholar 

  28. Law MR, Morris JK, Wald NJ. Use of BP lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665. doi:10.1136/bmj.b1665.

    Article  PubMed  CAS  Google Scholar 

  29. Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: A European society of hypertension task force document. Blood Press. 2009;18:308–47.

    Article  PubMed  CAS  Google Scholar 

  30. Aronow WS. What should the optimal blood pressure goal be in patients with diabetes mellitus or chronic kidney disease? Arch Med Sci. 2012;8:399–402.

    Article  PubMed  Google Scholar 

  31. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2003;26(1):S33–50.

    Google Scholar 

  32. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(1):S1–266.

    Google Scholar 

  33. Rosendorff C, Black HR, Cannon CP, et al. Treatment of hypertension in the prevention and management of ischemic heart disease. A scientific statement from the American heart association council for high blood pressure research and the councils on clinical cardiology and epidemiology and prevention. Circulation. 2007;115:2761–88.

    Article  PubMed  Google Scholar 

  34. Aronow WS. Treatment of hypercholesterolemia and hypertension in diabetics with coronary artery disease. Clinical Lipidology. 2012;7:689–95.

    Article  CAS  Google Scholar 

  35. Zanchetti A, Grassi G, Mancia G. When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? a critical appraisal. J Hypertens. 2009;27:923–34.

    Article  PubMed  CAS  Google Scholar 

  36. •• Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of hypertension of arterial hypertension: The task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). Eur Heart J. 2013;34:2159–219. This paper is the European Society of Hypertension/European Society of Cardiology 2013 guidelines document on management of hypertension.

    Article  PubMed  Google Scholar 

  37. Aronow WS. Hypertension guidelines. Hypertension. 2011;58:347–8.

    Article  PubMed  Google Scholar 

  38. Banach M, Michalska M, Kjeldsen SE, et al. What should be the optimal levels of blood pressure: Does the J-curve phenomenon really exist? Expert Opin Pharmacother. 2011;12:1835–44.

    Article  PubMed  Google Scholar 

  39. Banach M, Aronow WS. Should we have any doubts about hypertension therapy in elderly patients. ACCF/AHA 2011 expert consensus document on hypertension in the elderly. Pol Arch Med Wewn. 2011;121:253–8.

    PubMed  Google Scholar 

  40. Aronow WS, Banach M. Ten most important things to learn from the ACCF/AHA 2011 expert consensus document on hypertension in the elderly. Blood Pressure. 2012;21:3–5.

    Article  PubMed  Google Scholar 

  41. Aronow WS. Ten key points from the American College of Cardiology Foundation/American Heart Association 2011 expert consensus document on hypertension in the elderly. Am J Therap. In press

  42. Banach M, Aronow WS. Hypertension therapy in the elderly-do we know the answers to all the questions? The status after publication of the ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly. J Hum Hypertens. 2012;26:641–3.

    Article  PubMed  CAS  Google Scholar 

  43. Banach M, Aronow WS. Blood pressure J-curve: Current concepts. Curr Hypertens Rep. 2012;14:556–66.

    Article  PubMed  CAS  Google Scholar 

  44. Bangalore S, Qin J, Sloan S, et al. What is the optimal blood pressure in patients after acute coronary syndromes? Relationship of blood pressure and cardiovascular events in the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction (PROVE IT-TIMI) 22 trial. Circulation. 2010;122:2142–51.

    Article  PubMed  CAS  Google Scholar 

  45. Cooper-DeHoff RM, Gong Y, Handberg EM, et al. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA. 2010;304:61–8.

    Article  PubMed  CAS  Google Scholar 

  46. The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85.

    Article  Google Scholar 

  47. Mancia G, Schumacher H, Redon J, et al. Blood pressure targets recommended by guidelines and incidence of cardiovascular and renal events in the ongoing telmisartan alone and in combination with ramipril global endpoint trial (ONTARGET). Circulation. 2011;124:1727–36.

    Article  PubMed  Google Scholar 

  48. Redon J, Mancia G, Sleight P, et al. Safety and efficacy of low blood pressures among patients with diabetes. Subgroup analyses from the ONTARGET (ONgoing telmisartan alone and in combination with ramipril global endpoint trial). J Am Coll Cardiol. 2012;59:74–83.

    Article  PubMed  Google Scholar 

  49. Upadhyay A, Earley A, Haynes SM, Uhlig K. Systematic review: Blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med. 2011;154:541–8.

    Article  PubMed  Google Scholar 

  50. Banach M, Bhatia V, Feller MA, et al. Relation of baseline systolic blood pressure and long-term outcomes in ambulatory patients with chronic mild to moderate heart failure. Am J Cardiol. 2011;107:1208–14.

    Article  PubMed  Google Scholar 

  51. •• Ovbiagele B, Diener H-C, Yusuf S, et al. Level of systolic blood pressure within the normal range and risk of recurrent stroke. JAMA. 2011;306:2137–44. This paper discusses in 20,330 patients with a recent non-cardioembolic ischemic stroke the recurrent stroke rates for different blood pressure levels.

    Article  PubMed  CAS  Google Scholar 

  52. Ogihara T, Matsuoka H, Rakugi H. Practitioner's trial on the efficacy of antihypertensive treatment in elderly patients with hypertension II (PATE-hypertension II study) in Japan. Geriatr Gerontol Int. 2011;11:414–21.

    Article  PubMed  Google Scholar 

  53. Zhang Y, Zhang X, Liu L, et al. Is a systolic blood pressure target <140 mm Hg indicated in all hypertensives? Subgroup analyses of findings from the randomized FEVER trial. Eur Heart J. 2011;32:1500–8.

    Article  PubMed  Google Scholar 

  54. JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2008;31:2115–27.

    Article  Google Scholar 

  55. Zanchetti A, Liu L, Mancia G, et al. Stroke in hypertension optimal treatment (SHOT) trial: Protocol and organization (abstract). J Hypertens. 2013;31(A):e255.

    Google Scholar 

  56. Barylski M, Malyszko J, Rysz J, et al. Lipids, blood pressure, kidney-what was new in 2011? Arch Med Sci. 2011;7:1055–66.

    Article  PubMed  Google Scholar 

  57. Malyszko J, Bachorzewska-Gajewska H, Malyszko J, et al. Markers of kidney function in the elderly in relation to the new CKD-EPI formula for estimation of glomerular filtration rate. Arch Med Sci. 2011;7:658–64.

    Article  PubMed  CAS  Google Scholar 

  58. Banach M. Optimal blood pressure levels in elderly persons in the reasons for geographic and racial differences in stroke (REGARDS) cohort study. Clinical Trial Update Hot Line III session. European Society of Cardiology Annual Congress, Amsterdam 31st August-4th September, 2013.

  59. Aronow WS. Editorial commentary on dilemmas in treating hypertension in octogenarians. J Clin Hypertens. 2012;14:665–7.

    Article  Google Scholar 

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Wilbert S. Aronow declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by the author.

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  1. Cardiology Division, New York Medical College, Macy Pavilion, Room 138, Valhalla, NY, 10595, USA

    Wilbert S. Aronow

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Aronow, W.S. Hypertension-Related Stroke Prevention in the Elderly. Curr Hypertens Rep 15, 582–589 (2013). https://doi.org/10.1007/s11906-013-0384-x

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  • DOI: https://doi.org/10.1007/s11906-013-0384-x

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