Skip to main content

Advertisement

Log in

Treatment of hypertension and prevention of ischemic stroke

  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Data clearly indicate that treatment with antihypertensive drugs reduces the incidence of all strokes in men (by 34%), women (by 38%), elderly persons (by 36%), including those older than 80 years (by 34%), younger persons, those with systolic and diastolic hypertension, persons with isolated systolic hypertension, and in those with a history of stroke or transient ischemic attack (by 28%). Blood pressure should be reduced to less than 140/90 mm Hg. The overall data also suggest that reduction of stroke in persons with hypertension is related more to a reduction in blood pressure than to the type of antihypertensive drugs used.

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.

Similar content being viewed by others

References and Recommended Reading

  1. Garland C, Barrett-Connor E, Suarez L, Criqui MH: Isolated systolic hypertension and mortality after age 60 years. Am J Epidemiol 1983, 118:365–376.

    PubMed  CAS  Google Scholar 

  2. Stokes J III, Kannel WB, Wolf PA, et al.: The relative importance of selected risk factors for various manifestations of cardiovascular disease among men and women from 35 to 64 years old: 30 years of follow-up in the Framingham Study. Circulation 1987, 75(Suppl V):V–65-V–73.

    Google Scholar 

  3. Wolf PA: Cerebrovascular disease in the elderly. In Cardiovascular Disease in the Elderly Patient. Edited by Tresch DD, Aronow WS. New York: Marcel Dekker; 1994:125–147.

    Google Scholar 

  4. Aronow WS, Ahn C, Gutstein H: Risk factors for new atherothrombotic brain infarction in 664 older men and 1,488 older women. Am J Cardiol 1996, 77:1381–1383.

    Article  PubMed  CAS  Google Scholar 

  5. 1997 Joint National Committee: The sixth report of the Joint National Committee on the detection, evaluation, and treatment of high blood pressure (JNC VI). Arch Intern Med 1997, 157:2413–2444.

    Article  Google Scholar 

  6. Report by the Management Committee: The Australian Therapeutic Trial in Mild Hypertension. Lancet 1980, 1:1261–1267.

    Google Scholar 

  7. Medical Research Council Working Party: MRC trial of mild hypertension: principal results. Br Med J 1985, 291:97–104.

    Article  Google Scholar 

  8. Medical Research Council Working Party: MRC trial of treatment of hypertension in older adults: principal results. Br Med J 1992, 304:405–412.

    Google Scholar 

  9. Amery A, Birkenhager W, Brixko P, et al.: Morbidity and mortality results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet 1985, 1:1349–1354.

    Article  PubMed  CAS  Google Scholar 

  10. Coope J, Warrender TS: Randomised trial of the treatment of hypertension in elderly patients in primary care. Br Med J 1986, 293:1145–1151.

    CAS  Google Scholar 

  11. Dahlof B, Lindholm LH, Hansson L, et al.: Morbidity and mortality in the Swedish Trial in Old Patients With Hypertension (STOP Hypertension). Lancet 1991, 338:1281–1285.

    Article  PubMed  CAS  Google Scholar 

  12. Perry HM Jr., Davis BR, Price TR, et al.: Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke. The Systolic Hypertension in the Elderly Program (SHEP). JAMA 2000, 284:465–471. In this trial, 4736 men and women (mean age 72 years) with isolated systolic hypertension were randomized to chlorthalidone or placebo. At 4.5-year follow-up, compared with placebo, antihypertensive drug therapy significantly reduced the incidence of all first strokes by 37% (95% CI 19%–51%).

    Article  PubMed  Google Scholar 

  13. Staessen JA, Fagard R, Thijs L, et al.: 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 

  14. Wang J-G, Staessen JA, Gong L, et al.: Chinese trial on isolated systolic hypertension in the elderly. Arch Intern Med 2000, 160:211–220.

    Article  PubMed  CAS  Google Scholar 

  15. 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  Google Scholar 

  16. 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 

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

    Article  PubMed  CAS  Google Scholar 

  18. Gueyffier F, Boutitie F, Boissel J-P, et al.: Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. Ann Intern Med 1997, 126:761–767.

    PubMed  CAS  Google Scholar 

  19. Insua JT, Sacks HS, Lau T-S, et al.: Drug treatment of hypertension in the elderly: a meta-analysis. Ann Intern Med 1994, 121:355–362. A meta-analysis of nine trials that included 15,559 men and women older than 59 years showed that antihypertensive drug therapy significantly reduced the incidence of fatal stroke by 36% (95% CI, 18%-51%) and significantly reduced the incidence of stroke morbidity by 35% (95% CI, 24%–45%)

    PubMed  CAS  Google Scholar 

  20. Mulrow CD, Cornell JA, Herrera CR, et al.: Hypertension in the elderly. Implications and generalizability of randomized trials. JAMA 1994, 272:1932–1938.

    Article  PubMed  CAS  Google Scholar 

  21. Gueyffier F, Bulpitt C, Boissel J-P, et al.: Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. Lancet 1999, 353:793–796. A meta-analysis of 1670 persons aged 80 years and older with hypertension showed that antihypertensive drug therapy significantly reduced the incidence of all strokes by 34% (95% CI, 8%–52%).

    Article  PubMed  CAS  Google Scholar 

  22. Hansson L, Lindholm LH, Ekbom T, et al.: Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity. The Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999, 354:1751–1756.

    Article  PubMed  CAS  Google Scholar 

  23. Hansson L, Linhholm 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 

  24. Brown MJ, Palmer CR, Castaigne A, et al.: Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet 2000, 356:366–372.

    Article  PubMed  CAS  Google Scholar 

  25. Hansson L, Hedner T, Lund-Johansen P, et al.: Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000, 356:359–365.

    Article  PubMed  CAS  Google Scholar 

  26. 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 

  27. Kjeldsen SE, Dahlof B, Devereux RB: Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy. A Losartan Intervention For Endpoint Reduction (LIFE) substudy. JAMA 2002, 288:1491–1498.

    Article  PubMed  CAS  Google Scholar 

  28. Lindholm LH, Ibsen H, Dahlof B, et al.: Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002, 359:1004–1010.

    Article  PubMed  CAS  Google Scholar 

  29. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2000, 283:1967–1975.

    Article  Google Scholar 

  30. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: 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.

    Article  Google Scholar 

  31. Wing LMH, Reid CM, Ryan P, et al.: A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003, 248:583–592. In the Australian National Blood Pressure-2 study, 6083 men and women, mean age 72 years, with hypertension were randomized to enalapril or hydrochlorothiazide. At 4.1-year follow-up, the incidence of all strokes was similar in both treatment groups.

    Article  Google Scholar 

  32. Aronow WS: What is the appropriate treatment of hypertension in elders? J Gerontol Med Sci 2002, 57A:M483-M486.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aronow, W.S., Frishman, W.H. Treatment of hypertension and prevention of ischemic stroke. Curr Cardiol Rep 6, 124–129 (2004). https://doi.org/10.1007/s11886-004-0010-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-004-0010-2

Keywords

Navigation