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Optimal blood pressure target in stroke prevention
Alexandra Yannoutsos1, Céline Dreyfuss Tubiana, Michel E Safar
1Unité Hypertension Artérielle, Prévention et Thérapeutique Cardiovasculaires, Centre de Diagnostic et de Thérapeutique, AP-HP, Université Paris Descartes, Hôpital Hôtel-Dieu, Paris, France.
Insights
Individualized blood pressure (BP) goals are crucial for optimal stroke prevention. Tailoring BP targets based on age, comorbidities, and cerebrovascular disease ensures better patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Hypertension Research
Background:
- Generalized blood pressure (BP) goals may not ensure optimal stroke prevention for all individuals.
- Evidence suggests heterogeneity in target organ protection, with lower BP values potentially reducing stroke risk.
Purpose of the Study:
- To review the clinical relevance of individualized BP goals.
- To consider patient-specific factors like age, comorbidities, and cerebrovascular disease in BP management.
Main Methods:
- Review of observational and interventional data.
- Analysis of existing hypertension guidelines and their applicability.
Main Results:
- Lower BP targets may offer further stroke risk reduction but are not universally applicable.
- Ambitious BP targets may be unsuitable for aging individuals or those with established cerebrovascular disease.
Conclusions:
- Strict BP control is a priority for primary stroke prevention in early hypertensive individuals without arterial disease.
- In aging patients, difficult-to-control BP may indicate systemic arterial disease; delayed intervention carries risks.
- Stringent BP levels in stroke patients with cerebral small vessel lesions may accelerate cognitive decline.
Purpose Of Review:
A generalized single blood pressure (BP) goal may appear not suitable to achieve an optimal stroke prevention at the individual level. The aim of the present review is to consider the clinical relevance of individualized BP goal according to patient's age, comorbidities and established cerebrovascular disease.
Recent Findings:
Observational and interventional data support heterogeneity in target organ prevention in that lower BP values than recommended by hypertension guidelines are associated with further stroke risk reduction. However, more ambitious BP treatment targets appear not broadly applicable to ageing hypertensive individuals or patients with established cerebrovascular disease.
Summary:
Strict BP control in early diagnosed hypertensive individuals, without established arterial disease, should be a priority in primary stroke prevention. In ageing hypertensive individuals, difficult to control SBP can be considered as a marker of increased systemic arterial disease in the brain, the heart and the kidneys. A delayed aggressive intervention to reduce BP in these high-risk patients may be associated with a J-shaped relationship between BP level and adverse events. Moreover, patients suffering from stroke frequently presented with a high burden of small cerebral vessel lesions that are associated with an increased risk of cognitive decline progression, particularly with stringent BP levels.
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