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[Cerebral complications of hypertension in the elderly]
A S Rigaud1, O Hanon, P Bouchacourt
1Service de gérontologie, hôpital Broca, CHU Cochin-Port-Royal, 54-56, rue Pascal, 75013 Paris, France. anne-sophie.rigaud@brc.ap-hop-paris.fr
Insights
Hypertension management in the elderly can prevent serious brain complications like stroke and dementia. Antihypertensive drugs, including newer classes, are effective and safe for reducing morbidity and mortality.
Area of Science:
- Neurology
- Geriatrics
- Cardiovascular Medicine
Context:
- Hypertension is a significant risk factor for cerebral complications in the elderly.
- Elevated blood pressure, including isolated systolic hypertension and pulse pressure, contributes to brain damage.
- Antihypertensive treatment has been proven to reduce morbidity and mortality in older adults.
Purpose:
- To review the cerebral complications associated with hypertension in the elderly.
- To discuss the role of antihypertensive medications in preventing these complications.
- To highlight ongoing and future research in this field.
Summary:
- Cerebral complications of hypertension include stroke, cognitive impairment, and dementia, major causes of death in the elderly.
- Both traditional (diuretics, beta-blockers) and newer (calcium-channel blockers, ACE inhibitors) antihypertensive drugs are effective.
- Ongoing trials are investigating optimal treatment strategies and the specific benefits of certain drug classes for dementia prevention.
Impact:
- Effective hypertension management can significantly reduce the risk of stroke and cognitive decline in the elderly.
- Further research will refine treatment protocols for very elderly individuals and secondary stroke prevention.
- Understanding the role of antihypertensive drugs in dementia prevention is crucial for improving long-term neurological health.
Purpose:
This review focuses on cerebral complications of hypertension, which include stroke, impairment of cognitive function, dementia, and possibly depression and anxiety. These conditions are major causes of morbidity and mortality in the elderly.
Current Knowledge And Key Points:
Not only elevated diastolic blood pressure, but also isolated systolic hypertension and elevated pulse pressure play an important role in the development of brain complications. Randomised placebo-controlled trials have provided evidence that reduction of hypertension decreases safely and effectively morbidity and mortality rates in the elderly. The new classes of drugs, in particular calcium-channels blockers and angiotensin-converting enzyme inhibitors, have been shown to be as effective as the originally used diuretics and beta-blockers.
Future Prospects And Projects:
Several trials are currently in progress and should provide more information on the benefit of antihypertensive treatment in very elderly persons (Hypertension in the Very Elderly Trial, HYVET) and secondary prevention of stroke (PROGRESS). The importance of assessing new dosages of the presently used antihypertensive drugs as well as the benefit of new classes of drugs is emphasised. Further trials specifically focusing on the prevention of dementia by antihypertensive drugs are needed to confirm the results of the Syst-Eur Vascular Dementia Project. The benefit of calcium antagonists in the prevention of dementia in elderly hypertensive patients should be assessed in the Dementia Prevention in Hypertension trial (DEPHY).