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Blood Pressure Control and Primary Prevention of Stroke: Summary of Clinical Trial Data

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Hypertension and Stroke

Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

Abstract

Lowering elevated blood pressure (BP) significantly prevented stroke in many clinical trials. However, most trials have not reported results specifically in primary stroke prevention. Fixed-effects, random-effects, and network meta-analyses were therefore performed to estimate the effectiveness of antihypertensive drug therapy, using all data available in the published literature. In the eight placebo-controlled trials that reported numbers of observed first strokes, active drug therapy reduced the risk of stroke by 31% (95% confidence interval: 21–40%, P < 0.0001). This estimate was quite similar to those obtained from a variety of meta-analyses that included either all, or various subsets of, 33 placebo-controlled trials in hypertensive patients (including those that enrolled patients with a prior stroke). The number of strokes prevented was significantly and directly related to the absolute risk of stroke in the placebo group. Among trials comparing active antihypertensive drugs, only five were primary prevention studies. Thus, insufficient power precludes reliable estimates of comparative efficacy of antihypertensive drug classes in primary stroke prevention. In network meta-analysis of all 61 trials involving 349,078 subjects (most of whom had hypertension, and some of whom had prior strokes), 75 pair-wise comparisons, and 11,599 strokes, all antihypertensive drug classes showed significant prevention of stroke, compared to placebo or no treatment, with an initial diuretic or calcium antagonist being more effective than other drug classes. Although some suggest that calcium antagonists have a small (but significant) BP-independent effect on stroke prevention, the preponderance of the evidence indicates lower achieved blood pressures result in greater stroke prevention.

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  1. Department of Preventive Medicine, Rush Medical College at Rush University Medical Center, Chicago, IL, USA

    William J. Elliott MD, PhD

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  1. College of Medicine, Dept. Neurology, University of Illinois, 912 S. Wood Street Room 855 N, Chicago, 60612, Illinois, USA

    Venkatesh Aiyagari

  2. University of Illinois, Department of Neurology and Rehabilitati, College of Medicine at Chicago, S. Wood St 912, Chicago, 60612, Illinois, USA

    Philip B. Gorelick

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Elliott, W.J. (2011). Blood Pressure Control and Primary Prevention of Stroke: Summary of Clinical Trial Data. In: Aiyagari, V., Gorelick, P. (eds) Hypertension and Stroke. Clinical Hypertension and Vascular Diseases. Humana Press. https://doi.org/10.1007/978-1-60761-010-6_3

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