From the Research
For an 80-year-old female who experienced an ischemic stroke two weeks ago, the blood pressure goal should generally be below 130/80 mmHg, as intensive blood pressure lowering to this level has been shown to significantly reduce the risk of recurrent stroke compared to standard management with blood pressure levels below 140/90 mmHg 1. In the early post-stroke period, blood pressure management requires careful balance - too aggressive lowering could compromise cerebral perfusion, while uncontrolled hypertension increases risk of recurrent stroke. After the acute phase (beyond 72 hours), gradual blood pressure reduction is appropriate. For this patient who is now two weeks post-stroke, antihypertensive medications like ACE inhibitors (such as lisinopril 5-10mg daily) or ARBs (such as losartan 25-50mg daily) are often first-line choices, potentially combined with a thiazide diuretic if needed. Some guidelines suggest a target blood pressure of less than 140/90 mmHg for adults aged 80 years and older 2, but the most recent evidence supports a more aggressive approach with a target of less than 130/80 mmHg 1. Blood pressure should be monitored regularly, ideally with home measurements, and medication adjustments made gradually to avoid orthostatic hypotension, which is particularly concerning in elderly patients. Treatment should be individualized based on comorbidities, pre-stroke blood pressure, and medication tolerance. The goal is to reduce stroke recurrence risk while maintaining adequate cerebral perfusion and avoiding side effects that could lead to falls or other complications in this elderly patient. Lifestyle modifications, such as a healthy diet and regular physical activity, can also play a crucial role in reducing the risk of recurrent stroke 3, 4, 5.