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

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Book cover Hypertension and Stroke

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

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Abstract

Lowering elevated blood pressure 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 35 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 50 trials of initial antihypertensive therapy, involving 275,103 subjects (all hypertensive, but some with prior strokes), 62 pair-wise comparisons, and 8877 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 calcium antagonists may have a small 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 Biomedical Sciences, The Pacific Northwest University of Health Sciences, Yakima, WA, USA

    William J. Elliott M.D., Ph.D.

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  1. Departments of Neurological Surgery and Neurology and Neurotherapeutics , University of Texas Southwestern Medical Center , Dallas, Texas, USA

    Venkatesh Aiyagari

  2. Michigan State University Department of Translational Science & Molecular Medicine, Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan, USA

    Philip B. Gorelick

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Elliott, W.J. (2016). 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, Cham. https://doi.org/10.1007/978-3-319-29152-9_3

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