Secondary prevention of stroke by blood pressure-lowering treatment.
High blood pressure is the most important modifiable risk factor for stroke, accounting for more than 50% of the population-attributable fraction for stroke. There is now strong evidence from randomized trials that blood pressure-lowering treatment is one of the most effective and generalizable strategies for secondary prevention of stroke. Once the patient with stroke has stabilized, all patients should receive blood pressure-lowering therapy, irrespective of their blood pressure levels. Combination therapy with an angiotensin-converting enzyme (ACE) inhibitor plus a diuretic is an established regimen, but an angiotensin II-receptor blocker may provide an alternative regimen in patients who do not tolerate an ACE inhibitor, especially in combination with a diuretic. For patients with previous stroke, goal blood pressures of < 130/80 mm Hg in hypertensive subjects and < 120/80 mm Hg in normotensive (or "prehypertensive") subjects should be achieved using combination blood pressure-lowering therapy.
Arima
Hisatomi
H
The George Institute for International Health, University of Sydney, PO Box M201, Missenden Road, NSW 2050, Australia. jchalmers@thegeorgeinstitute.org
Chalmers
John
J
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002545:Brain Ischemia / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics