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Published on: February 10, 2023
Targeting blood pressure for stroke prevention: current evidence and unanswered questions
1Dijon Stroke Registry, E7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France. yannick.bejot@chu-dijon.fr.
Insights
Optimizing blood pressure (BP) management in stroke patients requires personalized strategies. Future research should explore optimal BP targets, drug choices, and consider factors like age, stroke type, comorbidities, and BP variability for better stroke prevention.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Clinical Pharmacology
Background:
- High blood pressure (BP) is a primary modifiable risk factor for stroke globally.
- Established benefits of BP reduction exist, yet optimal management in stroke patients remains under-explored.
Purpose of the Study:
- To review current knowledge on BP control for stroke prevention.
- To identify gaps and propose future research directions for personalized BP management in stroke survivors.
Main Methods:
- Review of existing randomized clinical trials and recent findings.
- Analysis of BP control in specific patient subgroups and clinical contexts.
Main Results:
- Current guidelines offer general BP reduction benefits but lack personalized thresholds and drug recommendations for stroke patients.
- Limited data exist for BP control in older adults, diverse stroke subtypes, and patients with comorbidities like diabetes.
Conclusions:
- Personalized BP management in stroke patients needs further investigation, considering individual factors and novel BP metrics.
- Future studies should focus on optimal BP targets, drug selection, circadian BP variations, and BP variability for improved stroke prevention.
Abstract:
High blood pressure (BP) is the leading modifiable risk factor of stroke worldwide. Although randomized clinical trials have demonstrated the beneficial effect of BP reduction on stroke risk, there are still insufficiently explored issues concerning the optimal personalized management of BP in stroke patients in terms of thresholds to be achieved and drug classes to be prescribed. Few data are available about BP control in specific clinical contexts such as in older patients, in various stroke subtypes, or in association with co-morbidities such as diabetes. In addition, although drug trials based their conclusions on achieved mean BP values, recent findings indicate that aspects such as circadian variations of BP and BP variability should be taken into account as well. This article aims to highlight current knowledge about BP control in stroke prevention and to provide new perspectives to be addressed in future studies so as to guide clinicians in their day-to-day practice.
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