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Reducing the Risk of Stroke in Elderly Patients with Hypertension

A Critical Review of the Efficacy of Antihypertensive Drugs

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Abstract

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.

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References

  1. Staessen JA, Wang J, Bianchi G, et al. Essential hypertension. Lancet 2003; 361: 1629–41

    Article  PubMed  Google Scholar 

  2. Di Carlo A, Lamassa M, Baidereschi M, et al., for the European BIOMED Study of Stroke Care Group. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke 2003; 34: 1114–9

    Article  PubMed  Google Scholar 

  3. Jorgensen HS, Nakayama H, Raaschou HO, et al. Acute stroke care and rehabilitation: an analysis of the direct cost and its clinical and social determinants. The Copenhagen Stroke Study. Stroke 1997; 28: 1138–41

    Article  PubMed  CAS  Google Scholar 

  4. Feigin V, Ratnasabapathy Y, Anderson C. Does blood pressure lowering treatment prevent dementia or cognitive decline in patients with cardiovascular and cerebrovascular disease? J Neurol Sci 2005; 229–230: 151–5

    Article  PubMed  Google Scholar 

  5. Nawrot T, Den Hond E, Thijs L, et al. Isolated systolic hypertension and the risk of vascular disease. Curr Hypertens Rep 2003; 5: 372–9

    Article  PubMed  Google Scholar 

  6. Safar ME, Benetos A. Factors influencing arterial stiffness in systolic hypertension in the elderly: role of sodium and the renin-angiotensin system. Am J Hypertens 2003; 16: 249–58

    Article  PubMed  CAS  Google Scholar 

  7. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease: part 2. Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335: 827–38

    Article  PubMed  CAS  Google Scholar 

  8. Turnbull F. Blood pressure lowering treatment trialists’ collaboration: effects of different blood-pressure-lowering regimens on major cardiovascular events. Results of prospectively-designed overviews of randomised trials. Lancet 2003; 362: 1527–35

    Article  PubMed  CAS  Google Scholar 

  9. Lawes CM, Bennett DA, Feigin VL, et al. Blood pressure and stroke: an overview of published reviews. Stroke 2004; 35: 776–85

    Article  PubMed  Google Scholar 

  10. Launer LJ, Masaki K, Petrovitch H, et al. The association between midlife blood pressure levels and late-life cognitive function: the Honolulu-Asia aging study. JAMA 1995; 274: 1846–51

    Article  PubMed  CAS  Google Scholar 

  11. Skoog I, Lernfelt B, Landahl S, et al. 15-year longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141–5

    Article  PubMed  CAS  Google Scholar 

  12. Kilander L, Nyman H, Boberg M, et al. Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension 1998; 31: 780–6

    Article  PubMed  CAS  Google Scholar 

  13. Tzourio C, Dufouil C, Ducimetiere P, et al. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology 1999; 53: 1948–52

    Article  PubMed  CAS  Google Scholar 

  14. Launer LJ, Ross GW, Petrovitch H, et al. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging 2000; 21: 49–55

    Article  PubMed  CAS  Google Scholar 

  15. Langa KM, Foster NL, Larson EB. Mixed dementia: emerging concepts and therapeutic implications. JAMA 2004; 292: 2901–8

    Article  PubMed  CAS  Google Scholar 

  16. Forette F, Seux ML, Staessen JA, et al. The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med 2002; 162: 2046–52

    Article  PubMed  Google Scholar 

  17. Forette F, Seux ML, Staessen JA, et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352: 1347–51

    Article  PubMed  CAS  Google Scholar 

  18. Tuomilehto J, Rastenyte D, Birkenhager WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84

    Article  PubMed  CAS  Google Scholar 

  19. Messerli FH, Grossman E, Goldbourt U. Are beta-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review. JAMA 1998; 279: 1903–7

    Article  PubMed  CAS  Google Scholar 

  20. Fournier A, Messerli FH, Achard JM, et al. Cerebroprotection mediated by angiotensin II: a hypothesis supported by recent randomized clinical trials. J Am Coll Cardiol 2004; 43: 1343–7

    Article  PubMed  Google Scholar 

  21. Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? Lancet 2004; 364: 1684–9

    Article  PubMed  CAS  Google Scholar 

  22. de Leeuw PW. Nonsteroidal anti-inflammatory drugs and hypertension: the risks in perspective. Drugs 1996; 51: 179–87

    Article  PubMed  Google Scholar 

  23. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–53

    Article  Google Scholar 

  24. Kjeldsen SE, Dahlöf B, Devereux RB, et al. Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: a Losartan Intervention for Endpoint Reduction (LIFE) sub-study. JAMA 2002; 288: 1491–8

    Article  PubMed  CAS  Google Scholar 

  25. Lithell H, Hansson L, Skoog I, et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86

    Article  PubMed  CAS  Google Scholar 

  26. Degl’Innocenti A, Elmfeldt D, Hofman A, et al. Health-related quality of life during treatment of elderly patients with hypertension: results from the Study on COgnition and Prognosis in the Elderly (SCOPE). J Hum Hypertens 2004; 18: 239–45

    Article  PubMed  Google Scholar 

  27. Papademetriou V, Farsang C, Elmfeldt D, et al. Stroke prevention with the angiotensin II type 1-receptor blocker candesartan in elderly patients with isolated systolic hypertension: the Study on COgnition and Prognosis in the Elderly (SCOPE). J Am Coll Cardiol 2004; 44: 1175–80

    PubMed  CAS  Google Scholar 

  28. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004; 363: 2022–31

    Article  PubMed  CAS  Google Scholar 

  29. 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

  30. 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 

  31. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 2002; 288: 2981–97

    Article  Google Scholar 

  32. Bulpitt CJ, Beckett NS, Cooke J, et al. Results of the pilot study for the hypertension in the very elderly trial. J Hypertens 2003; 21: 2409–17

    Article  PubMed  CAS  Google Scholar 

  33. 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 

  34. Sander GE. High blood pressure in the geriatric population: treatment considerations. Am J Geriatr Cardiol 2002; 11: 223–32

    Article  PubMed  CAS  Google Scholar 

  35. Khalili P, Nilsson PM, Nilsson JA, et al. Smoking as a modifier of the systolic blood pressure-induced risk of cardiovascular events and mortality: a population-based prospective study of middle-aged men. J Hypertens 2002; 20: 1759–64

    Article  PubMed  CAS  Google Scholar 

  36. Messerli FH, Grossman E, Lever AF. Do thiazide diuretics confer specific protection against strokes? Arch Intern Med 2003; 163: 2557–60

    Article  PubMed  CAS  Google Scholar 

  37. Nilsson PM, Gudbjornsdottir S, Eliasson B, et al. Hypertension in diabetes: trends in clinical control in repeated large-scale national surveys from Sweden. J Hum Hypertens 2003; 17: 37–44

    Article  PubMed  CAS  Google Scholar 

  38. Asmar R. Benefits of blood pressure reduction in elderly patients. J Hypertens 2003; 21 (6 Suppl.): S25–30

    CAS  Google Scholar 

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Medicine, University Hospital, S-205 02, Malmö, Sweden

    Peter M. Nilsson

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  1. Peter M. Nilsson
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Correspondence to Peter M. Nilsson.

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Nilsson, P.M. Reducing the Risk of Stroke in Elderly Patients with Hypertension. Drugs Aging 22, 517–524 (2005). https://doi.org/10.2165/00002512-200522060-00005

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