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Hypertension and stroke
1Department of Medicine and Nephrology B, Herlev Hospital, Denmark.
Insights
Antihypertensive treatment significantly reduces stroke risk, preventing most excess risk associated with hypertension. However, stroke risk may not be fully reversible with blood pressure lowering drugs, and acute stroke management requires careful consideration of blood pressure levels.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Hypertension is a primary risk factor for all stroke types, including hemorrhagic, ischemic, and lacunar strokes.
- Modern antihypertensive treatments have demonstrated significant success in stroke prevention.
- The complete reversibility of stroke risk through blood pressure reduction is still under investigation.
Purpose of the Study:
- To summarize the impact of antihypertensive treatment on stroke risk.
- To discuss the management of blood pressure in acute stroke patients.
- To highlight potential risks of blood pressure reduction in specific stroke scenarios.
Main Methods:
- Review of controlled trials and observational studies on hypertension and stroke.
- Analysis of data regarding the efficacy of antihypertensive treatment in stroke prevention.
- Consideration of hemodynamic factors in acute stroke management.
Main Results:
- Antihypertensive treatment effectively eliminates excess stroke risk associated with hypertension in controlled trials.
- Observational studies suggest stroke risk may not always be fully reversible with drug-induced blood pressure lowering.
- In acute stroke, spontaneous blood pressure normalization is often preferred, avoiding aggressive reduction except in extreme cases.
Conclusions:
- Antihypertensive therapy is crucial for preventing strokes, including transient ischemic attacks.
- Careful management of blood pressure is essential in acute stroke to prevent complications like ischemic stroke.
- Overly aggressive blood pressure reduction can precipitate ischemic events, particularly in severe hypertension or elderly patients.
Abstract:
HYPERTENSION AND STROKE: Hypertension is a major risk factor for stroke, and stroke prevention is the most important achievement of modern antihypertensive treatment. In controlled trials, a few years of this treatment can eliminate the entire excess stroke risk associated with hypertension. In observational studies, stroke risk appears to be not always fully reversible when the blood pressure is lowered with drugs. Hypertension is associated with an increased incidence of both haemorrhagic, ischaemic and lacunar stroke. It is likely that antihypertensive treatment prevents all these types of strokes as well as transient ischaemic attacks.
Acute Stroke:
In acute stroke, a transient rise in blood pressure is common, in some cases superimposed on chronic hypertension. No major controlled trials have reported findings on whether blood pressure should be lowered acutely in such patients. On the basis of observational studies and haemodynamic considerations, it seems prudent to leave all but the highest blood pressures in acute stroke to settle spontaneously. ISCHAEMIC STROKE: Ischaemic stroke may occasionally be precipitated by overzealous blood pressure reduction. This has been reported in particular in the initial treatment of very severe hypertension, and occasionally in the elderly hypertensive. It may also occur in the rare cases where transient cerebral ischaemia is haemodynamically induced.