Action on Vascular Risk Factors: Importance of Blood Pressure and Lipid Lowering in Stroke Secondary Prevention

Abstract

Introduction: Secondary stroke prevention comprises a broad spectrum of therapeutic actions that includes the appropriate management of risk factors and the action on blood pressure and serum lipids that are of great importance to decrease stroke recurrences. Methods: We conducted a review of the published studies analyzing the relevance of the treatment of blood pressure and serum lipids, with special attention to recent findings of clinical trials and current guidelines on stroke secondary prevention. Results: The relationship between blood pressure and stroke has been widely demonstrated; however, the role of serum lipids has been discussed for a long time. Recent results from epidemiological studies and clinical trials have demonstrated its role as modifiable risk factor for stroke. Blood pressure and lipid lowering are associated with significant reductions in recurrent strokes as well as in other vascular events in transient ischemic attack (TIA) or stroke patients. The PROGRESS and MOSES trials suggest that diuretics, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers could confer additional benefits in stroke patients, and the SPARCL study did so for statins. These drugs are not only efficacious in the reduction of stroke recurrences, but also in other cardiovascular events. Conclusions: Blood pressure and serum lipids are two important and modifiable vascular risk factors that should be taken into consideration when planning secondary stroke prevention measures. This approach should include hypotensive drugs (mainly the combination of diuretics and ACE inhibitors) with the objective to maintain normal blood pressure, avoiding levels >130/80 mm Hg in all stroke patients, and statins (atorvastatin 80 mg) in patients with noncardioembolic TIA or stroke.

Renal Function Predicts Survival in Patients with Acute Ischemic Stroke

“…We did not adjust for stroke severity, treatment received during the index hospitalization or medications and lifestyle factors following stroke [15,16,17] in the primary analyses, since these factors may be downstream consequences occurring after the development of reduced or highly elevated eGFR. In sensitivity analyses we additionally controlled for correlates of stroke severity.…”

Are there Differences in Stroke Prevention with Different Blood Pressure Lowering Agents?

“…In primary prevention there may be marginal cerebrovascular benefits for regimens that include an angiotensin-converting inhibitor, an angiotensin II type-1 receptor blocker and calcium channel blocker, but the available data are not definitive. Although it is acknowledge that new studies are needed to asses whether a specific drug regimen is better than the other, for secondary prevention, current guidelines recommend the use of diuretics and the combination of angiotensin-converting inhibitors and diuretics or angiotensin II receptor blockers to reduce stroke recurrence [5,71,72].…”

“…All forms of arterial hypertension, i.e. isolated systolic and diastolic hypertension, and their combinations increase stroke risk [5].…”

“…Few studies have demonstrated significant benefits with hypotensive drugs in secondary prevention of stroke with different results, mainly related to the different hypotensive drugs used [5]. In the early 70s, Carter [43] included 99 hypertensive ischemic stroke patients with a follow-up of 2.5 years and reported a 66% relative risk reduction for stroke compared to placebo.…”

Lipid-Lowering Drugs in Ischemic Stroke Prevention and Their Influence on Acute Stroke Outcome

“…Dyslipidemia is a recognized risk factor for coronary arterial disease, but its role as a risk factor for stroke has been controversial for a long time [1]. Prior observational cohort studies showed no clear relationship between serum cholesterol and stroke.…”