Primary and secondary prevention of stroke: control of arterial hypertension

Abstract:

Arterial hypertension is the major risk factor for ischaemic and haemorrhagic stroke and silent brain infarction. Therefore, antihypertensive treatment is the most important approach to stroke risk reduction. International and national guidelines recommend antihypertensive treatment for both primary and secondary prevention. All stroke patients and patients with transient ischaemic attack (TIA) should be considered as high-risk patients. Hypertension increases the risk of recurrent strokes. There are limited data directly addressing the role of hypertension treatment in individuals with stroke or TIA. No consensus exists as to when the antihypertensive treatment should be started in the initial phase. Experimental and clinical data suggest that reducing the activity of the renin-angiotensin aldosterone system (RAAS) may have beneficial effects beyond lowering the blood pressure. There is increasing evidence of cerebroprotective effects of RAAS-modifying agents, such as angiotensin receptor antagonists or angiotensin converting enzyme (ACE) inhibitors. Currently, the most important goal in primary and secondary prevention of stroke is a strict blood pressure control. Antihypertensive treatment is recommended for prevention of both recurrent stroke and other vascular events in individuals with a history of ischaemic stroke or TIA.

Key words:
antihypertensive agents; hypertension; primary prevention; secondary prevention; stroke