M. Bachir Tazkarji, MD, CCFP, CAQ Geriatric Medicine, Lecturer, Family Medicine Department, University of Toronto, Toronto, ON; Toronto Rehabilitation Institute, Toronto; Family Physician, Summerville Family Health Team, Mississauga, ON.

Arterial hypertension is one of the most important and preventable causes of death worldwide; therefore, adequate treatment of high blood pressure should be mandatory for patients with hypertension. Hypertension is defined on the basis of systolic and diastolic blood pressure levels and classified into stages on the basis of the degree of elevation. Normal blood pressure is widely considered as being less than 120/80 mm Hg. The presence of risk factors such as elevated blood cholesterol, smoking, diabetes, and obesity greatly increases the risk for hypertension-related morbid events.
Cardiovascular disease and stroke disproportionately affect older adults. Blood pressure is a potent modifiable target for reducing the risk for stroke and cardiovascular morbidity and mortality in older adults. In clinical trials, the number needed to treat to prevent one cardiovascular death was 79, one fatal or nonfatal stroke was 48, and one fatal or nonfatal coronary event was 64.
Key words: blood pressure, myocardial infarction, CVA, cardiovascular risk, older adults.

Sonal Singh, MD, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Yoon K. Loke, MBBS, MD, University of East Anglia, School of Medicine, Health Policy and Practice, Norwich, UK.

Cardiovascular disease is the leading cause of mortality among older adults with type II diabetes. The thiazolidinediones (rosiglitazone and pioglitazone) lower blood sugar levels among individuals with type II diabetes. The thiazolidinediones have favourable effects on surrogate markers of cardiovascular disease such as microalbuminuria, carotid intimal thickness, and blood pressure. Emerging evidence from recent randomized clinical trials has confirmed both that thiazolidinediones increase the risk of heart failure, and that rosiglitazone increases the risk of myocardial infarction among those with type II diabetes. Clinicians should avoid thiazolidinediones for older individuals with type II diabetes who are at risk for cardiovascular events as the negative cardiovascular effects of the thiazolidinediones outweigh any potential benefits on surrogate markers.
Key words: thiazolidinediones, pioglitazone, rosiglitazone, heart failure, myocardial infarctions.