Antihypertensive and lipid lowering treatment in stroke prevention: current state and future.
Diabetes mellitus, arterial hypertension, smoking are major stroke risk factors. The role of hypercholesterolemia in stroke has not been established yet. In patients with type 2 diabetes mellitus there is evidence that intensive glucose lowering therapy diminishes the risk of microvascular complications. In all patients with stroke or transient ischemic attack (TIA), blood pressure should be lowered irrespectively of the baseline level with either diuretics, angiotensin converting enzyme (ACE) inhibitors, beta-blockers, or calcium antagonists. The role of angiotensin II (AT2) receptor blockers has not been established so far. In general terms a global approach to management of patients with vascular risk factors should be developed. An extended follow-up of randomised trials on preventive therapy should be completed. Controlled trials comparing angiotensin receptor blockers with ACE inhibitors should be started. Further research may focus on the new lipid lowering agents, and on the comparison of single lipid lowering agent vs. combinations in stroke prevention. These efforts should help in finding the best vasoprotective strategy in stroke prevention.
Piechowski-Jóźwiak
Bartłomiej
B
Department of Neurology, CHUV, Lausanne, Switzerland. bpiechow@amwaw.edu.pl
Bogousslavsky
Julien
J
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000592:standards; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D011945:Receptors, Angiotensin / Q000378:metabolism; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D011945:Receptors, Angiotensin