title: Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence.
abstract: OBJECTIVE
  It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke.
  
  
  RESULTS
  A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak.
  
  
  CONCLUSIONS
  A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.
authors: aIstituto Auxologico Italiano bUniversità di Milano, Milan, Italy cFuWai Hospital and Cardiovascular Institute dBeijing Hypertension League Institute, Beijing, China eUniversità Milano-Bicocca fIRCCS Multimedica, Sesto San Giovanni, Milan, Italy gOslo University Hospital, Oslo, Norway hUniversity of Valencia, Madrid, Spain iMedical University of Gdansk, Gdansk, Poland jUniversity of Glasgow, Glasgow, UK kLund University, Scania University Hospital, Malmo, Sweden lTallinn University of Technology, Tallinn, Estonia mEuropean Hospital Georges Pompidou, Paris, France nUniversità di Brescia, Spedali Civili, Brescia, Italy oBeijing Anzhen Hospital, Beijing pShanghai Hypertension Institute, Shanghai, China qComplutense University rHospital 12 de Octubre sHospital Clínico San Carlos, Madrid, Spain tCentro Hospitalar de Entre o Douro e Vouga, E.P.E., Portugal uNephrology and Hypertension, University Hospital, Erlangen, Germany vUniversity Hospital of Lausanne, Lausanne, Switzerland wMedical University of Lodz, Lodz, Poland xCharles University Medical School I and Thomayer Hospital, Prague, Czech Republic ySt. Imre University Teaching Hospital, Budapest, Hungary zAlmazov Federal Heart, Blood and Endocrinology Center, St. Petersburg, Russia aaRSPC Cardiology, Minsk, Belarus abNSC 'Institute of Cardiology named after N.D. Strazhesko' of NAMS, Kiev, Ukraine acEmergency Hospital of Bucharest, Bucharest, Romania adUniversity Hospital Saint Anna, Sofia, Bulgaria aeDr Peter Drzai Hospital, Ljubljana, Slovenia afUniversity Hospital Center Zagreb, Zagreb, Croatia agClinic for Internal Medicine InterMedic, Nis, Serbia ahCardiology Department, Asklepeion General Hospital, Athens, Greece aiNicosia General Hospital, Nicosia, Cyprus ajIstanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey akHasharon Hospital - Rabin Medical Center, Petach-Tikva, Israel alBeijing Xuanwu Hospital amSecond Affiliate Hospital, Beijing University anMilitary General Hospital, Beijing, China aoH
authors: Alberto
authors: A
authors: Zanchetti
authors: Lisheng
authors: L
authors: Liu
authors: Giuseppe
authors: G
authors: Mancia
authors: Gianfranco
authors: G
authors: Parati
authors: Guido
authors: G
authors: Grassi
authors: Marco
authors: M
authors: Stramba-Badiale
authors: Vincenzo
authors: V
authors: Silani
authors: Grzegorz
authors: G
authors: Bilo
authors: Giovanni
authors: G
authors: Corrao
authors: Antonella
authors: A
authors: Zambon
authors: Lorenza
authors: L
authors: Scotti
authors: Xinhua
authors: X
authors: Zhang
authors: HayYan
authors: H
authors: Wang
authors: Yuqing
authors: Y
authors: Zhang
authors: Xuezhong
authors: X
authors: Zhang
authors: Ting Rui
authors: TR
authors: Guan
authors: Eivind
authors: E
authors: Berge
authors: Josep
authors: J
authors: Redon
authors: Krzysztof
authors: K
authors: Narkiewicz
authors: Anna
authors: A
authors: Dominiczak
authors: Peter
authors: P
authors: Nilsson
authors: Margus
authors: M
authors: Viigimaa
authors: Stéphane
authors: S
authors: Laurent
authors: Enrico
authors: E
authors: Agabiti-Rosei
authors: Zhaosu
authors: Z
authors: Wu
authors: Dingliang
authors: D
authors: Zhu
authors: José Luis
authors: JL
authors: Rodicio
authors: Luis Miguel
authors: LM
authors: Ruilope
authors: Nieves
authors: N
authors: Martell-Claros
authors: Fernando
authors: F
authors: Pinto
authors: Roland E
authors: RE
authors: Schmieder
authors: Michel
authors: M
authors: Burnier
authors: Maciej
authors: M
authors: Banach
authors: Renata
authors: R
authors: Cifkova
authors: Csaba
authors: C
authors: Farsang
authors: Alexandra
authors: A
authors: Konradi
authors: Irina
authors: I
authors: Lazareva
authors: Yuriy
authors: Y
authors: Sirenko
authors: Maria
authors: M
authors: Dorobantu
authors: Arman
authors: A
authors: Postadzhiyan
authors: Rok
authors: R
authors: Accetto
authors: Bojan
authors: B
authors: Jelakovic
authors: Dragan
authors: D
authors: Lovic
authors: Athanasios J
authors: AJ
authors: Manolis
authors: Philippos
authors: P
authors: Stylianou
authors: Serap
authors: S
authors: Erdine
authors: Dror
authors: D
authors: Dicker
authors: Gangzhi
authors: G
authors: Wei
authors: Chengbin
authors: C
authors: Xu
authors: Hengge
authors: H
authors: Xie
authors: Antonio
authors: A
authors: Coca
authors: John
authors: J
authors: O'Brien
authors: Gary
authors: G
authors: Ford
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D002784:Cholesterol; D008078:Cholesterol, LDL / Q000097:blood*; D003071:Cognition; D003072:Cognition Disorders / Q000517:prevention & control*; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*
chemical_list: D008078:Cholesterol, LDL; D002784:Cholesterol