Cerebrovascular protection and antihypertensive therapy

Our aim is to review the association between blood pressure and stroke and analyse data from randomized controlled trials involving diverse therapies, especially those regarding the renin-angiotensin system. In addition, an overview of stroke pathogenesis is given and its relationship with treatment action mechanisms reviewed.

Stroke is a leading cause of death worldwide. In addition, many survivors of stroke suffer different degrees of disability. Because of the ageing of the global population, especially in regions of rapid economic growth, stroke will remain the second leading cause of death and in terms of disability it will be among the five most important causes in both developing and developed countries. High blood pressure is the most important risk factor for stroke, either ischemic or haemorrhagic, and established hypertension is the most prevalent modifiable risk factor. Data from controlled trials of blood-pressure-lowering treatment have demonstrated that treatment considerably lowers the risk of stroke within a few years of starting treatment. However, there exists controversy about the most efficient treatment regimen for primary and secondary prevention of stroke among the different blood-pressure-lowering treatments.

Debate rages as to whether the benefits of treating high blood pressure are simply determined by the quality of blood-pressure control, or whether the choice of drug therapy adds or detracts from the expected benefits of blood-pressure reduction. The desirable future interventional comparative studies should consent to determine specific effects of drug classes on cardiovascular risk in the absence of the confounding effect of a relevant blood-pressure reduction that may counteract the potential blood-pressure-independent benefits of specific drug classes.