[Prevention of cardiovascular complications after a stroke or TIA: hypotensive and hypocholesterolemic therapy].
In patients who have recently had a TIA or stroke, the risk of new serious cardiovascular disease is decreased by the pharmacological reduction of the serum cholesterol level and blood pressure; this has been convincingly demonstrated by randomised clinical trials. There is sufficient evidence that cholesterol-lowering treatment is effective in patients with a TIA or cerebral infarction who have a total cholesterol > or = 3.5 mmol/l. The results from a trial in patients with only a TIA or a minor stroke will have to answer the question whether cholesterol-lowering treatment will be effective in patients > 80 years, and whether higher dosages of simvastatin will be more effective in these patients. Antihypertensive therapy is effective in preventing recurrent stroke and myocardial infarction in patients with a recent stroke or TIA. It is obvious that the treatment should be started with a diuretic and that a second agent should be added if necessary. On epidemiological grounds, vigorous treatment is also justified in patients with a normal or mildly elevated blood pressure; caution and a custom-tailored approach are essential, however, in each individual patient.
Dippel
D W
DW
Erasmus Medisch Centrum, afd. Neurologie, Postbus 1738, 3000 DR Rotterdam. d.dippel@erasmusmc.nl
van der Worp
H B
HB
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents