Hypertension and cerebrovascular disease

Abstract

Stroke is a common problem in the United States and causes significant morbidity and mortality. In addition both the personal and economic costs of stroke are high. Chronic arterial hypertension is the most significant modifiable risk factor for stroke (ischemic and hemorrhagic), both because of it's high relative risk for stroke and also because of it's prevalence in the general population. In addition hypertension remains under-recognized and under-treated. Newer studies have demonstrated that more aggressive treatment of hypertension results in lower cardiovascular morbidity and mortality, including that due to stroke. Consequently, new definitions for hypertension and new recommendations for treatment have recently been published. Furthermore, certain conditions, such as stroke, have been determined to be a “compelling indication” for certain classes of antihypertension therapy. Chronic hypertension is an important cause of the vascular pathology which leads to stroke and intracerebral hemorrhage. Acute stroke and cerebral hemorrhage may also cause an acute rise in blood pressure. Treatment of elevated blood pressure during acute stroke must balance the theoretical risk of worsening the stroke due to reduced cerebral perfusion against the benefits of lowering blood pressure (reduced risk of hemorrhage, cerebral edema, and other end-organ damage). This has been made more challenging since the approval of thrombolytic therapy for acute ischemic stroke. Also, severely elevated blood pressure can also cause hypertensive encephalopathy which must be distinguished from stroke so that appropriate treatment can be instituted as quickly as possible.