Hypertension and stroke

Abstract

Objectives: Stroke is a major cause of neurological disability in the elderly and the second leading cause of death worldwide. It represents a heavy socio-economical burden because stroke survivors require chronic care. Can stroke incidence be reduced by treating the risk factors for stroke? Is there evidence based rational for antiplatelet therapy in the primary and secondary prevention of ischemic stroke? Methods: Data from the literature and trials are reviewed to give evidence based recommendations on the primary and secondary prevention of ischemic stroke. Results: Hypertension is the most common and the most potent and modifiable risk factor because it is present in 70% of patients with stroke. Reduction of fatal and non-fatal stroke rate is documented in all grades of HTN and also in elderly >65 years old by effective antihypertensive treatment. Antihypertensive therapy has the highest success rate in the primary prevention of stroke. Lowering BP in hypertensive and non-hypertensive patients with previous stroke or TIA (secondary prevention) is also beneficial. BP reduction in acute ischemic stroke is a two-edged sword: careful lowering of elevated blood pressure is required. Antiplatelet therapy is useful in the primary and secondary prevention of acute stroke. Conclusions: Primary and secondary prevention of stroke are cost effective and recommended. There are no recommended treatment modalities according to the recent guidelines for the management of patients with acute ischemic stroke.