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The Impact of Uncontrolled Hypertension on the Cerebrovascular System

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Interventional Therapies for Secondary and Essential Hypertension

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

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Abstract

The relationship between stroke mortality and blood pressure has been demonstrated in observational studies including more than one million individuals. However, one of the most important unresolved questions is how far blood pressure should be lowered to prevent the first stroke and recurrences. Most available data comes from post hoc analyses of clinical trials on the prevention of morbidity and mortality. The European Society of Hypertension and the Chinese Hypertension League have designed the Stroke in Hypertension Optimal Treatment (SHOT)trial (Zanchetti et al., J Hypertens 32(9):1888–1897, 2014), a prospective, multinational, randomized trial comparing three different systolic blood pressure targets: (1) <145–135, (2) <135–125, and (3) <125 mmHg in 7500 patients aged at least 65 years with hypertension and stroke, and the results are expected in 2018. There is also growing evidence supporting the idea that high blood pressure in middle age is related to cognitive decline and dementia in the elderly. Several clinical trials of antihypertensive drugs and their meta-analyses have shown that reductions in blood pressure lower the incidence of cognitive decline and dementia. As yet, there is no robust evidence that suggests some antihypertensive drugs or strategies are better than others in reducing the risk of dementia, although some trials in very elderly patients suggest that calcium channel blockers are more effective in delaying cognitive decline in hypertensive patients.

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Abbreviations

BMI:

Body mass index

BP:

Blood pressure

CCB:

Calcium channel blocker

CI:

Confidence interval

DBP:

Diastolic blood pressure

INVEST:

INternational VErapamil SR-Trandolapril

MI:

Myocardial infarction

NEMESIS:

North East Melbourne Stroke Incidence Study

ONTARGET:

Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial

SBP:

Systolic blood pressure

SHOT:

Stroke in hypertension optimal treatment

SMMSE:

Standardized Mini-Mental State Exam

Syst-Eur:

Systolic Hypertension in Europe trial

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Authors and Affiliations

  1. Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

    Mónica Domenech MD, PhD & Antonio Coca MD, PhD, FRCP, FESC

Authors
  1. Mónica Domenech MD, PhD
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  2. Antonio Coca MD, PhD, FRCP, FESC
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Corresponding author

Correspondence to Antonio Coca MD, PhD, FRCP, FESC .

Editor information

Editors and Affiliations

  1. First Cardiology Clinic, National and Kapodistrian University of Athens, Athens, Greece

    Costas Tsioufis

  2. Department of Nephrology and Hypertension, University Hospital Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany

    Roland E. Schmieder

  3. IRCCS Istituto Auxologico Italiano, University Milano-Bicocca, Milano Monza, Italy

    Giuseppe Mancia

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Domenech, M., Coca, A. (2016). The Impact of Uncontrolled Hypertension on the Cerebrovascular System. In: Tsioufis, C., Schmieder, R., Mancia, G. (eds) Interventional Therapies for Secondary and Essential Hypertension. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-34141-5_6

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  • DOI: https://doi.org/10.1007/978-3-319-34141-5_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-34140-8

  • Online ISBN: 978-3-319-34141-5

  • eBook Packages: MedicineMedicine (R0)

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