-While hypertension is the leading modifiable risk factor for stroke, age is the most important one. An 85 year old is 20-35 times more likely to suffer a stroke than a 55 year old with an identical BP over the following 10 years.
-While this observational data shows the prevalence of stroke rises with BP/age, interventional trials in the elderly (HYVET) and those treated to more intensive targets (SPRINT) show clear improvements in CV outcomes with lower achieved pressures.
-As such, elderly patients are the
most likely to benefit from anti-hypertensive therapy (lower number needed to treat) and shouldn't be considered "too old" for medications.
-I maintain or intensify BP control as the patient ages with careful consideration of co-morbid conditions, patient frailty, diastolic pressures, and BP tolerability.