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(Hypertension. 2006;48:203.)
© 2006 American Heart Association, Inc.

Editorial Commentaries

Control of Blood Pressure After Stroke

From the Institute of Neuroscience, University of Nottingham, United Kingdom.

Correspondence to Philip Bath, Division of Stroke Medicine, University of Nottingham, South Block, D Floor, Queen’s Medical Centre, Nottingham, NG7 2UH United Kingdom. E-mail Philip.bath@nottingham.ac.uk

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Acornerstone of primary stroke prevention is built on treating "hypertension" in asymptomatic subjects who are usually at low or medium vascular risk, dogma based on the results of numerous randomized, controlled trials and meta-analyses of them. Similarly, several trials have shown that blood pressure (BP) should be lowered in patients who have had a recent stroke.^1–3 Note here the distinction between treating hypertension in primary prevention and lowering BP in secondary prevention.

Three randomized trials were of sufficient size to help determine clinical practice in patients with cerebrovascular disease. The Post-stroke Antihypertensive Treatment Study (PATS) found that treatment with the thiazide-like diuretic, indapamide, reduced BP (by 5/2 mm Hg) and stroke recurrence by 29% in 5665 Chinese patients.¹ In contrast, the Heart Outcomes Prevention Evaluation (HOPE) Study was a trial of ramipril (angiotensin converting enzyme inhibitor [ACE-I]) in 9297 patients with high vascular risk in which 1013 patients had a history of previous stroke. Within this subgroup, ramipril was effective at reducing BP (by 11/4 mm Hg) whereas the composite outcome of stroke, myocardial infarction (MI), and vascular death was reduced by 30%. The largest trial to date was the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS), which assessed a treatment regime based on another ACE-I, perindopril, given with or without indapamide (at the investigators choice) in 6105 patients with previous ischemic stroke or primary intracerebral hemorrhage.³ Overall, active treatment was associated with a relative risk reduction (RRR) in stroke of 28%; however, combined treatment (perindopril+indapamide) was far more effective . . . [Full Text of this Article]