Related Experiment Videos
Why do treated hypertensives suffer strokes? An internist's perspective.
1Medical Service, VA Medical Center and University of Minnesota Medical School, Minneapolis, MN 55417, USA. simo016@tc.umn.edu
Journal of Clinical Hypertension (Greenwich, Conn.)
|October 9, 2002
Summary
Hypertension treatment effectively prevents lacunar strokes but is less effective for atherothrombotic and cardioembolic strokes. Future research should focus on these subtypes, considering factors beyond blood pressure for stroke prevention.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Stroke remains a leading cause of death despite widespread hypertension management.
- Antihypertensive therapy shows greater efficacy in preventing hemorrhagic strokes than ischemic strokes.
Purpose of the Study:
- To investigate why antihypertensive therapy is only partially effective in preventing ischemic strokes.
- To explore differences in pathogenesis and treatment across ischemic stroke subtypes.
Main Methods:
- Analysis of stroke subtypes: small-vessel arteriopathic (lacunar), large-artery atherothrombotic, and cardioembolic.
- Review of the role of hypertension in the pathogenesis of each subtype.
- Consideration of overtreatment effects (J-curve phenomenon) in specific populations.
Main Results:
- Hypertension is a primary cause of lacunar strokes, largely preventable with antihypertensive therapy.
- Hypertension plays a lesser role in atherothrombotic strokes, which are less impacted by current antihypertensive treatments.
- Overtreatment of hypertension, particularly in the elderly, may paradoxically increase stroke risk.
Conclusions:
- Judicious antihypertensive therapy is crucial for preventing lacunar strokes.
- Future therapeutic strategies must target atherothrombotic and cardioembolic stroke prevention.
- Promising avenues include surgical refinement, plaque stabilization pharmacotherapy, and advanced diagnostics like transesophageal echocardiography.