Antihypertensive treatment as a possible cause of stroke in the elderly

There have been a few reports on stroke as a side-effect of antihypertensive treatment. To study the occurrence of this side-effect, a questionnaire was sent to all Dutch nursing homes (n = 322). Thirty patients were reported with signs of cerebral ischaemia shortly after starting antihypertensive and diuretic drugs. Nine of these cases were well documented with full data on blood pressure, measured immediately after the event and compared with pretreatment levels. A review of cases reported in the literature is presented. It is concluded that, especially in elderly patients, an abrupt fall in blood pressure may induce cerebral ischaemia, sometimes resulting in stroke. Antihypertensive treatment in the elderly should therefore start with a small dose, the aim being to reduce blood pressure gradually.