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Abstract
BackgroundWhile hypertension is a leading risk factor for an initial stroke, the role of blood pressure lowering to prevent subsequent stroke is less clear. The results of recent large clinical trials investigating effects of antihypertensive agents in patients with a history of stroke have not shown a significant benefit; findings that are at odds with previous data. Our meta-analysis systematically evaluates the available, relevant trials to examine the role of antihypertensive drugs in preventing recurrent stroke.MethodsMEDLINE, CENTRAL, and ClinicalTrials.gov were systematically searched and bibliographies from key reports were examined. All randomized, placebo-controlled trials that tested blood pressure lowering agents in patients with stroke or transient ischemic attack were identified. The results from these trials were combined and meta-analyses were performed.ResultsTen studies were found to contain relevant endpoints and presented data allowing meta-analysis. Agents that lowered blood pressure reduced recurrent stroke (OR 0.71, 95% CI 0.59-0.86, P = 0.0004) and cardiovascular events (OR 0.69, 95% CI 0.57-0.85, P = 0.0004) in patients with a previous stroke or TIA. These agents did not affect the rate of myocardial infarction (OR 0.86, 95% CI 0.73-1.01, P = 0.07) or all-cause mortality (OR 0.95, 95% CI 0.83-1.07, P = 0.39) in this patient population.ConclusionDespite recent large trials showing no significant effect, in patients that have experienced a TIA or stroke, blood pressure lowering agents reduced the occurrence of subsequent stroke and cardiovascular events. The rate of myocardial infarction and all-cause mortality was unchanged.
Highlights
While hypertension is a leading risk factor for an initial stroke, the role of blood pressure lowering to prevent subsequent stroke is less clear
Ten randomized clinical trials were identified as having study participants with prior transient ischemic attack (TIA), stroke or "reversible
(page number not for citation purposes) http://www.intarchmed.com/content/2/1/30 ischemic neurologic defect" who were chronically treated with a blood pressure lowering agent [8,10,13,18,19,20,21,22,23,24]
Summary
While hypertension is a leading risk factor for an initial stroke, the role of blood pressure lowering to prevent subsequent stroke is less clear. Our meta-analysis systematically evaluates the available, relevant trials to examine the role of antihypertensive drugs in preventing recurrent stroke. Hypertension is the leading risk factor for cerebrovascular accident [1] and increases the risk of stroke sevenfold [2]. While primary prevention of stroke must include adequate blood pressure (BP) control, BP control in the secondary prevention of stroke is less clear. Individuals who suffer a stroke or transient ischemic attack (TIA) are at increased risk for another cardiovascular event [3]. While lowering BP during an acute cerebrovascular accident remains controversial, there may be a benefit to lowering blood pressure after the acute phase of the event has passed. BP is strongly associated with (page number not for citation purposes)
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