Primary and secondary prevention of stroke by antihypertensive drug treatment.
Hypertension is the most powerful risk factor for stroke. Antihypertensive drug treatment reduces the incidence of stroke. In a meta-analysis of actively controlled trials, calcium-channel blockers, including (-8%; p = 0.07) or excluding verapamil (-10%; p = 0.02), as well as angiotensin Type 1 receptor blockers (-24%; p = 0.0002) resulted in better stroke prevention than the old drugs (diuretics or beta-blockers), whereas the opposite trend was observed for angiotensin-converting enzyme inhibitors (+10%; p = 0.03). An overview of six trials conducted in patients with a history of cerebrovascular disease demonstrated that blood pressure-lowering therapy reduced stroke recurrence by 25% (p = 0.004). A meta-regression analysis showed that within-trial differences in systolic blood pressure accounted for the prevention of stroke in most trials. This finding was corroborated by the recently published Valsartan Antihypertensive Long-term Use Evaluation trial.
Wang
Ji-Guang
JG
Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, Ruijin 2nd Road 197, Shanghai 200025, China. jiguangwang@netscape.net
Li
Yan
Y
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015201:Meta-Analysis as Topic; D016017:Odds Ratio; D012044:Regression Analysis; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D000959:Antihypertensive Agents