Skip to main content
Log in

Antihypertensive treatment and stroke prevention: From recent meta-analyses to the PRoFESS trial

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Blood pressure control is the cornerstone of therapeutic interventions aimed at preventing first strokes and recurrent strokes. All antihypertensive drug classes may be useful in preventing cerebrovascular events, depending on their efficacy in lowering elevated blood pressure values and achieving blood pressure control. However, recent findings indicate that drugs acting on the renin-angiotensin system (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) may exert cerebrovascular protective effects in addition to blood pressure reduction. This article examines the cerebrovascular protection provided by antihypertensive drug treatment in the light of the results of recent meta-analyses and of the findings of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Chalmers J, Todd A, Chapman N, et al.: International Society of Hypertension (ISH): statement on blood pressure lowering and stroke prevention. J Hypertens 2003, 21:651–663.

    Article  PubMed  Google Scholar 

  2. Mancia G, Ambrosioni E, Rosei EA, et al.: Blood pressure control and risk of stroke in untreated and treated hypertensive patients screened from clinical practice: results of the ForLife study. J Hypertens 2005, 23:1575–1581.

    PubMed  CAS  Google Scholar 

  3. Mancia G, De Backer G, Dominiczak A, et al.: 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007, 25:1105–1187.

    Article  PubMed  CAS  Google Scholar 

  4. Goldstein LB, Adams R, Alberts MJ, et al.: Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council. Circulation 2006, 113:e873–e923.

    Article  PubMed  Google Scholar 

  5. Mancia G, Grassi G: Secondary prevention of stroke: old and new evidence. Aging Clin Exp Res 2002, 14:216–220.

    PubMed  Google Scholar 

  6. Yusuf S, Diener HC, Sacco RL, et al.; for PRoFESS Study Group: Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med 2008, 359:1225–1237.

    Article  PubMed  CAS  Google Scholar 

  7. Wolf PA, Abbott RD, Kannel WB: Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991, 22:983–988.

    PubMed  CAS  Google Scholar 

  8. Prospective Studies Collaboration: Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet 1995, 346:1647–1653.

    Article  Google Scholar 

  9. MacMahon S, Peto R, Cutler J, et al.: Blood pressure, stroke, and coronary heart disease. Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990, 335:765–774.

    Article  PubMed  CAS  Google Scholar 

  10. Stamler J, Stamler R, Neaton JD: Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. Arch Intern Med 1993, 153:598–615.

    Article  PubMed  CAS  Google Scholar 

  11. Collins R, MacMahon S: Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 1994, 50:272–298.

    PubMed  CAS  Google Scholar 

  12. Mancia G, Seravalle G, Grassi G: Systolic blood pressure: an underestimated cardiovascular risk factor. J Hypertens 2002, 20(Suppl 5):S21–S27.

    CAS  Google Scholar 

  13. Domanski MJ, Davis BR, Pfeffer MA, et al.: Isolated systolic hypertension: prognostic information provided by pulse pressure. Hypertension 1999, 34:375–380.

    PubMed  CAS  Google Scholar 

  14. Benetos A, Rudnichi A, Safar M, Guize L: Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension 1998, 32:560–564.

    PubMed  CAS  Google Scholar 

  15. Nielsen WB, Lindenstrom E, Vestbo J, Jensen GB: Is diastolic hypertension an independent risk factor for stroke in the presence of normal systolic blood pressure in the middle-aged and elderly? Am J Hypertens 1997, 10:634–639.

    Article  PubMed  CAS  Google Scholar 

  16. Laurent S, Katsahian S, Fassot C, et al.: Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 2003, 34:1203–1206.

    Article  PubMed  Google Scholar 

  17. Boutouyrie P, Bussy C, Lacolley P, et al.: Association between local pulse pressure, mean blood pressure, and large-artery remodelling. Circulation 1999, 100:1387–1393.

    PubMed  CAS  Google Scholar 

  18. D’Agostino RB, Wolf PA, Belanger AJ, Kannel WB: Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke 1994, 25:40–43.

    PubMed  Google Scholar 

  19. Straus SE, Majumdar SR, McAlister FA: New evidence for stroke prevention: scientific review. JAMA 2002, 288:1388–1395.

    Article  PubMed  Google Scholar 

  20. Staessen JA, Wang JG, Thijs L: Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet 2001, 358:1305–1315.

    Article  PubMed  CAS  Google Scholar 

  21. Gueyffier F, Boissel JP, Boutitie F, et al., for the INDANA (INdividual Data ANalysis of Antihypertensive intervention trials) Project Collaborators: Effect of antihypertensive treatment in patients having already suffered from stroke. Gathering the evidence. Stroke 1997, 28:2557–2562.

    PubMed  CAS  Google Scholar 

  22. PROGRESS Collaborative Group: Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001, 358:1033–1041.

    Article  Google Scholar 

  23. PATS Collaborating Group: Post-stroke antihypertensive treatment study. A preliminary result. Chin Med J (Engl) 1995, 108:710–717.

    Google Scholar 

  24. Yusuf S, Sleight P, Pogue J, et al., for the Heart Outcomes Prevention Evaluation Study Investigators: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000, 342:145–153.

    Article  PubMed  CAS  Google Scholar 

  25. Hansson L, Zanchetti A, Carruthers SG, et al., for the HOT Study Group: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998, 351:1755–1762.

    Article  PubMed  CAS  Google Scholar 

  26. Bilous R: Blood pressure control in type 2 diabetes-What does the United Kingdom Prospective Diabetes Study (UKPDS) tell us? Nephrol Dial Transplant 1999, 14:2562–2564.

    Article  PubMed  CAS  Google Scholar 

  27. Hansson L: Treatment of hypertension and the J curve. J Clin Hypertens (Greenwich) 1999, 1:136–140.

    Google Scholar 

  28. Gueyffier F, Bulpitt C, Boissel JP, et al.: Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. Lancet 1999, 353:793–796.

    Article  PubMed  CAS  Google Scholar 

  29. Bulpitt CJ, Beckett NS, Cooke J, et al.: Results of the pilot study for the Hypertension in the Very Elderly Trial. J Hypertens 2003, 21:2409–2417.

    Article  PubMed  CAS  Google Scholar 

  30. Staessen JA, Fagard R, Thijs L, et al., for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997, 350:757–764.

    Article  PubMed  CAS  Google Scholar 

  31. Mancia G, Grassi G: Systolic and diastolic blood pressure control in antihypertensive drug trials. J Hypertens 2002, 20:1461–1464.

    Article  PubMed  CAS  Google Scholar 

  32. Klungel OH, Stricker BH, Paes AH, et al.: Excess stroke among hypertensive men and women attributable to under-treatment of hypertension. Stroke 1999, 30:1312–1318.

    PubMed  CAS  Google Scholar 

  33. Andersson OK, Almgren T, Persson B, et al.: Survival in treated hypertension: follow up study after two decades. BMJ 1998, 317:167–171.

    PubMed  CAS  Google Scholar 

  34. Benetos A, Thomas F, Bean KE, Guize L: Why cardiovascular mortality is higher in treated hypertensives versus subjects of the same age, in the general population. J Hypertens 2003, 21:1635–1640.

    Article  PubMed  CAS  Google Scholar 

  35. Hansson L, Lindholm LH, Niskanen L, et al.: Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: The Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999, 353:611–616.

    Article  PubMed  CAS  Google Scholar 

  36. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997.

  37. Lithell H, Hansson L, Skoog I, et al.: The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003, 21:875–886.

    Article  PubMed  CAS  Google Scholar 

  38. Dahlof B, Devereux RB, Kjeldsen SE, et al.: Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): A randomised trial against atenolol. Lancet 2002, 359:995–1003.

    Article  PubMed  CAS  Google Scholar 

  39. Reboldi G, Angeli F, Cavallini C, et al.: Comparison between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the risk of myocardial infarction, stroke and death: a meta-analysis. J Hypertens 2008, 26:1282–1289.

    Article  PubMed  CAS  Google Scholar 

  40. Pitt B, Segal R, Martinez FA, et al.: Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet 1997, 349:747–752.

    Article  PubMed  CAS  Google Scholar 

  41. Pitt B, Poole-Wilson PA, Segal R, et al.: Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II. Lancet 2000, 355:1582–1587.

    Article  PubMed  CAS  Google Scholar 

  42. Barnett AH, Bain SC, Bouter P, et al.; Diabetics Exposed to Telmisartan and Enalapril Study Group: Angiotensinreceptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004, 351:1952–1961.

    Article  PubMed  CAS  Google Scholar 

  43. Dickstein K, Kjekshus J: Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan. Lancet 2002, 360:752–760.

    Article  PubMed  CAS  Google Scholar 

  44. Pfeffer MA, McMurray JJ, Velazquez EJ, et al.: Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003, 349:1893–1906.

    Article  PubMed  CAS  Google Scholar 

  45. Yusuf S, Teo KK, Pogue J, et al.: Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008, 358:1547–1559.

    Article  PubMed  CAS  Google Scholar 

  46. Blood Pressure Lowering Treatment Trialists’ Collaboration, Turnbull F, Neal B, et al.: Blood pressure-dependent and independent effects of agents that inhibit the rennin-angiotensin system. J Hypertens 2007, 25:951–958.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Guido Grassi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grassi, G., Quarti-Trevano, F., Dell’Oro, R. et al. Antihypertensive treatment and stroke prevention: From recent meta-analyses to the PRoFESS trial. Current Science Inc 11, 265–270 (2009). https://doi.org/10.1007/s11906-009-0045-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-009-0045-2

Keywords

Navigation