[Antihypertensive therapy in stroke: acute therapy, primary and secondary prevention]

Arterial hypertension represents the single most important treatable risk factor for stroke, therefore antihypertensive treatment is crucial. Observational studies have shown that in the acute phase of an ischemic stroke blood pressure is elevated during the first few days and helps to restore cerebral perfusion, activates collateral arterial supply and enhances the treatment goal of minimizing infarct size. Especially for acute ischemic strokes with stable deficits drug treatment of hypertension therefore is recommended only at systolic pressures of > or = 220 mm Hg or with diastolic pressures of > or = 120 mm Hg except when heart, lung or renal failure are also present. In primary prevention of stroke there is a large potential for hypertension treatment which reduces the relative risk by 42%. Especially elderly people with moderate hypertension should be treated. One vascular event per year can be avoided in 100 patient treatment years. Only scarce data exist on secondary prevention of stroke which show that hypertension treatment has a major importance for the modification of risk factors.