A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.

No abstract

It has been calculated that 925 patients would reach the primary outcome after a mean 4-year follow-up, and this should provide at least 80% power to detect a 25% stroke difference between SBP targets and a 20% difference between LDL-C targets.

Autonomic nervous system and microvascular alterations at pre-hypertensive stage of hypertension have still not been fully elucidated. We aimed at addressing central and local influences on microvascular reactivity at pre-hypertensive stage of hypertension. To that end, we studied microvascular reactivity in 59 normotensives with a family history of hypertension and 46 controls. We measured laser-Doppler flow on the finger nailfold skin in the resting condition, after an 8-min occlusion of digital arteries and during local nitroglycerin application. Finger pressure, pulse and ECG were monitored by a Finapres device. Heart rate power spectral analysis was performed using Fast Fourier transformation. Baroreflex sensitivity was estimated by the sequence method. Normotensives with a family history of hypertension showed higher systolic pressure, decreased high-frequency power of the heart rate variability spectrum and reduced baroreflex sensitivity in the resting condition as well as decreased fundamental frequency of laser-Doppler flow oscillations during nitroglycerin application. We conclude that normotensives with a family history of hypertension exhibit altered sympathovagal balance with decreased parasympathetic activity at the cardiac level as well as increased myogenic microvascular reactivity.

This study was designed to address alterations in autonomic nervous system activity in normotensive subjects with a family history of hypertension. We compared the autonomic nervous system activity in 59 normotensives with a family history of hypertension and 46 normotensives with no family history of hypertension. Skin blood flow was measured using laser-Doppler method on the nailfold skin in the resting condition, during systemic cooling and during upright tilting. Finger blood pressure, pulse and ECG were monitored by a finapres device. Heart rate, systolic pressure and microvascular flow power spectral analyses were performed using fast Fourier transformation. Baroreflex sensitivity was estimated with the sequence method. Compared to the control group, normotensives with a family history of hypertension showed significantly higher systolic pressure, decreased proportion and area of the high-frequency band of the heart rate variability power spectrum and reduced baroreflex sensitivity in the resting condition as well as a decreased proportion and area of the high-frequency band of the heart rate variability power spectrum during systemic cooling. We also proved a different time course of baroreflex sensitivity during upright tilting in the two groups. In contrast, we did not find any significant differences in the parameters of systolic pressure and microvascular variability power spectra between the two groups. Our results indicate that even normotensives with a family history of hypertension exhibit an increased ratio of sympathetic to parasympathetic activity at the cardiac level; however, they do not show any alteration of the vascular sympathetic reactivity.