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The role of blood pressure lowering before and after stroke

Geoffrey A Donnan1, Stephen M Davis, Amanda Thrift

  • 1National Stroke Research Institute, Austin & Repatriation Medical Centre, University of Melbourne, West Heidelberg, and Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia. gdonnan@unimelb.edu.au

Current Opinion in Neurology
|January 25, 2003
PubMed

Insights

Lowering blood pressure effectively prevents strokes, both initially and recurrently. Evidence supports various agents for primary prevention and perindopril-based therapy for secondary stroke prevention, though its use in acute stroke remains uncertain.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Hypertension Research

Background:

  • Elevated blood pressure is a primary risk factor for stroke incidence and recurrence.
  • Blood pressure management significantly impacts outcomes in patients experiencing acute stroke.

Purpose of the Study:

  • To review recent randomized controlled trials (RCTs) on blood pressure management for stroke prevention and acute stroke care.
  • To evaluate the efficacy of blood pressure lowering strategies in primary and secondary stroke prevention.
  • To assess the current evidence regarding blood pressure management in acute stroke settings.

Main Methods:

  • Analysis of findings from key randomized controlled trials including HOPE, LIFE, SCOPE, ANBP2, and PROGRESS.
  • Review of evidence from the Perindopril Protection against Recurrent Stroke Study (POISE).
  • Examination of data from the Acute Candesartan Cilexetil Evaluation in Stroke Survivors (ACESS) trial.

Main Results:

  • Blood pressure lowering protects against stroke irrespective of baseline blood pressure levels, supported by multiple large-scale trials.
  • Angiotensin system blockade may offer additional protective benefits for stroke prevention.
  • Perindopril-based therapy demonstrates efficacy in reducing stroke events for secondary prevention in both hypertensive and normotensive individuals.
  • Evidence for blood pressure management in acute stroke is uncertain, though some trials suggest potential benefits.

Conclusions:

  • Blood pressure lowering is recommended for primary stroke prevention using diverse therapeutic agents.
  • Perindopril-based therapy is indicated for secondary stroke prevention based on current evidence.
  • Further research is needed to clarify the safety and efficacy of blood pressure lowering in acute stroke.
Abstract

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