Evidence from randomized controlled trials (RCTs) supports the use of antihypertensive agents in the secondary prevention of patients with ischemic stroke (IS) or transient ischemic attack (TIA).1,2 However, since heterogeneity is present for several outcomes among these trials, current recommendations do not specifically address the intensity of blood pressure (BP) lowering for secondary stroke prevention. 1,2This heterogeneity has been attributed to both a potential class effect of antihypertensive drugs used (related also to the reduction of BP variability) 3 and differences in the degree of BP reduction using standard and aggressive antihypertensive strategies. 4 Moreover, the majority of RCTs of secondary stroke prevention did not specifically evaluate the association between the extent of BP reduction and long-term outcomes in patients with stroke or TIA, leading to increasing uncertainty about the optimal BP levels that should be aimed and achieved during secondary stroke prevention. 5,6 In view of the former considerations, we conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using available RCT data on secondary stroke prevention. Methods Trial Identification and Data AbstractionThis meta-analysis has adopted the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for systematic reviews and meta-analyses.7 Eligible RCTs of all antihypertensive treatments used in the secondary prevention of IS/TIA Abstract-Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention.

TCD is more sensitive but less specific compared to TTE for the detection of PFO in patients with cryptogenic cerebral ischemia. The overall diagnostic yield of TCD appears to outweigh that of TTE.

Colchicine is a tricyclic, lipid-soluble alkaloid derived from the plant of the Lily family Colchicum autumnale, sometimes called the "autumn crocus". It is predominantly metabolized in the gastrointestinal tract. Two proteins, P-glycoprotein (P-gp) and CYP3A4 seem to play a pivotal role, governing its pharmacokinetic. The commonest side effects are gastrointestinal (nausea, vomiting and particularly dose-related-diarrhea) occurring in 5-10% of patients. Colchicine exerts its unique action mainly through inhibition of microtubule polymerization. Microtubule polymerization affects a variety of cellular processes including maintenance of shape, signaling, division, migration, and cellular transport. Colchicine interferes with several inflammatory pathways including adhesion and recruitment of neutrophils, superoxide production, inflammasome activation, the RhoA/Rho effector kinase (ROCK) pathway and the tumor necrosis factor alpha (TNF-α) -induced nuclear factor κΒ (NF-κΒ) pathway attenuating the inflammatory response. This concise paper attempts to give a brief review of its pharmacokinetic properties and its main mechanisms of action.