Blood Pressure Control and Primary Prevention of Stroke: Summary of the Recent Clinical Trial Data and Meta-Analyses

Abstract

Stroke is the second most common cause of death worldwide and of adult disability, but in the near future the global burden of cerebrovascular diseases will rise due to ageing and adverse lifestyle changes in populations worldwide. The risk of stroke increases at blood pressure levels above 115/75 mm Hg and high blood pressure (BP) is the most important modifiable risk factor for stroke, associated with 54 % episodes of stroke worldwide. There is strong evidence from clinical trials that antihypertensive therapy reduces substantially the risk of any type of stroke, as well as stroke-related death and disability. The risk attributed to BP is associated not only with absolute values but also with certain parameters describing BP diurnal pattern as well as short-term and long-term variability. Many studies reported that certain features of BP like nocturnal hypertension, morning surge or increased variability predict an increased stroke risk. However, there is no accepted effective modality for correction of these disturbances (chronotherapy, certain classes of antihypertensive drugs). In the elderly, who are mostly affected by stroke, the primary prevention guidelines recommend treatment with diuretics and calcium channel blockers to lower blood pressure to the standard level.

Treatment of Hypertension: Favourable Effect of the Twice-Daily Compared to the Once-Daily (Evening) Administration of Perindopril and Losartan

“…In non-dipper hypertension the number of cardiac events is three times more compared to the dipper type [5,12,13,[15][16][17]. In asymptomatic hypertensive patients who underwent 24-hour monitoring and brain magnetic resonance imaging, the frequency of asymptomatic cerebrovascular damage (silent infarcts and advanced deep white matter ischemic lesions) was higher in non-dippers as compared to dippers, and extreme dippers had more advanced cerebrovascular lesions [18].…”

Risk factors frequencies for cerebrovascular stroke and a role of a licenced nurse in their prevention / Učestalost riziko faktora kod cerebrovaskularnog inzulta i uloga diplomirane medicinske sestre/tehničara u prevenciji

“…Postojanje više faktora rizika, dužina njihovog trajanja, kao i izraženost svakog faktora ponaosob, stoji u pozitivnoj korelaciji sa pojavom moždanog udara. Prema nekim podacima, kod bolesnika koji nisu imali nijedan ili su imali jedan od važećih faktora rizika, rizik da za pet godina dobiju moždani udar je bila 22%, u poređenju sa rizikom od 42% koju su imali bolesnici sa tri ili četiri izražena faktora rizika (8,9,10).…”

“…Postojanje više faktora rizika, dužina njihovog trajanja, kao i izraženost svakog faktora ponaosob, stoji u pozitivnoj korelaciji sa pojavom moždanog udara. Prema nekim podacima, kod bolesnika koji nisu imali nijedan ili su imali jedan od važećih faktora rizika, rizik da za pet godina dobiju moždani udar je bila 22%, u poređenju sa rizikom od 42% koju su imali bolesnici sa tri ili četiri izražena faktora rizika (8,9,10).Faktori rizika za nastanak moždanog udara su istovremeno i faktori rizika za aterosklerozu i generalno se mogu podijeliti na faktore na koje se ne može uticati i faktore na koje se može uticati, kojima se mora posvetiti veća pažnja. Faktori rizika gde liječenje nije moguće su: uzrast, pol, hereditet, rasa/entitet i geografska lokalizacija.…”

“…Faktori rizika gde liječenje nije moguće su: uzrast, pol, hereditet, rasa/entitet i geografska lokalizacija. Faktori rizika nastanka moždanog udara koji se mogu lečiti su: hipertenzija, dijabetes melitus, hiperlipidemija, pušenje cigareta, pijenje alkohol, gojaznost i nedovoljna fi zička aktivnost (9,10).…”

Stroke and Hypertension in High-Risk African Americans

“…These include masked hypertension, the nocturnal BP pattern, and circadian BP variability [ 59 ]. These could represent other potential explanations for the higher stroke risk among blacks in general, but clearly more studies of these associations are needed.…”