[Treatment in the primary prevention of stroke--still not fully used option]

Several studies have shown that pharmacological treatment of systolic-diastolic hypertension or isolated systolic hypertension in elderly persons would result in several years in a significant decrease (more than 40%) of stroke. Occurrence of strokes decreased in the Czech Republic in years 1985 till 2002 by more than 40%, which represents about two thirds of the decrease observed in the USA. Nevertheless, we cannot be satisfied with the treatment of hypertension in the Czech Republic because only 18% of patients are effectively treated for the hypertension, with BP < 140/90 mm Hg. Not well controlled hypertension results namely from the minimal use of the combination treatment. From the point of prognosis for the hypertensive patients older than 50 years, the level of systolic pressure is more important than the diastolic pressure. The risk of development of the stroke rises from the level of systolic blood pressure 115 mmHg almost linearly. Calcium channel blockers or diuretics represent the most appropriate therapy of the isolated systolic hypertension of elderly patients. The risk of stroke is higher also in persons with elevated blood pressure in the morning. That is why in elderly patients the use of drugs effectively controlling blood pressure during 24 hours is necessary. Recent studies (HOPE study, PROGRESS study) have demonstrated that the reduction of blood pressure decreases the occurrence of stroke not only in hypertensive patients, but also in the normotensive persons during the primary and secondary prevention. Review data show that 27% of ischemic strokes and 57% of hemorhagic strokes, which happened in the "treated" hypertensive patients, are due to not well controlled hypertension. Missing treatment of hypertension is responsible for 22.8% of strokes in men and 25.4% in women. The given data show a big reserve for the possibility to decrease further the stroke incidence in the population.