• Cheng-Hsuan Li, Sung-Ju Hsueh, Li-Kai Tsai, Wei-Hung Chang, Shao-Yi Cheng, Hao-Min Cheng, Chih-Fan Yeh, Yen-Hung Lin, and Hsin-Hsi Tsai.
• Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsin-Chu, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
• J Formos Med Assoc. 2025 Jan 15.

AbstractControlling hypertension has become an important issue in the elderly population in whom neurological comorbidities are highly prevalent. Most of the large-scale trials focusing on hypertension management in older populations have excluded patients with comorbid neurological disorders. However, this population requires special considerations, as the benefits of antihypertensive agents are mostly uncertain and there is a higher risk of adverse events. In this review article, we discuss current evidence regarding the management of elderly patients with hypertension and common neurological disorders, including stroke and neurodegenerative diseases. In elderly patient with a history of stroke, the blood pressure management strategy is generally similar to that for young patients, however the benefits of stroke prevention from blood pressure control are less significant. For patients with neurodegenerative disorders such as cognitive dysfunction and Parkinson's disease, achieving adequate blood pressure control may be beneficial in reducing cardiovascular risks, although the higher risk of adverse events from antihypertensive treatment may offset some of these benefits. Special considerations for factors such as orthostatic hypotension, risk of falls, polypharmacy, and significant drug-drug interactions are required but frequently neglected in clinical practice. More efforts are warranted to determine the optimal treatment strategy for elderly populations with neurological disorders.Copyright © 2025 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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