Alteration of blood pressure regulation and cerebrovascular disorders in the elderly

The objective of this study was to review the available data on the effects of management of hypertension on stroke in the elderly. MED-LINE was searched for articles published from 1967 to 1991 for articles on hypertension and hypotension. The following "key words" were used to limit our search to relevant studies: "stroke", "cerebrovascular disease", "elderly", "hypertension", "hypotension", "drug trials in hypertension", "complications of acute stroke", and "stroke management". Original articles with data related to the effects of hypertension management or complications of hypotension were reviewed in detail. Of about 900 papers reviewed, 121 were selected for this review. These papers specifically addressed the long-term prognosis of subjects treated with antihypertensive medications, the prognosis after TIA or stroke, and complications of aggressive antihypertensive therapy. The incidence of hypertension increases with age. Hypertension is the most important correctable risk factor for stroke. Most studies on stroke prevention in asymptomatic hypertension (primary prevention) have shown clear benefits (including management of systolic hypertension in the elderly). Data on stroke prevention in patients with TIAs (secondary prevention) is limited but suggests that management of hypertension will decrease the risk of stroke in such patients. Patients with completed stroke who are hypertensive should have very careful management of their hypertension as they may be at risk for hypotensive complications. Sudden reduction in blood pressure in the elderly (especially in the presence of pseudohypertension) increases the risk of symptomatic cerebral hypoperfusion and stroke. Management of hypertension in the elderly is effective in stroke prevention. Because of the real risk of a sudden decrease in cerebral perfusion, pressure reduction should be done slowly and with care.