Hypertension and Stroke: 2005 Canadian Hypertension Educational Program Recommendations

Abstract

Stroke is the leading cause of disability in North America and the third leading cause of death. 1 Hypertension is well recognized as the most important modifiable risk factor for both ischemic stroke and intracerebral hemorrhage. 2 A significant number of Canadians have one or more major risk factors for stroke. More than 50% of Canadians aged from 55 to 74 years old are hypertensive. 3 More than 160,000 people in the United States in 2001 had a fatal stroke and about 540,000 more people suffered a non fatal stroke in the same period. 1 A recent population-based study using an administrative health database showed an incidence of stroke in urban and rural Alberta of 132.4 /100,000 population/year and 138.2/100,000 population/year respect-ively. 4 For males over 80 years old, the incidence of stroke reaches 500/100 000 population/year. 4 In ABSTRACT: Background: Hypertension is the most important modifiable cause of stroke. The Canadian Hypertension Educational Program, representing Canada's experts in the field of hypertension, publishes annual evidence-based recommendations on the diagnosis and treatment of hypertension. Methods: We present the 2005 Canadian Hypertension Educational Program guidelines regarding the management of hypertension in patients with stroke. Results: The diagnosis of hypertension should be expedited and can be made as early as the second visit in patients with stroke. Unless contraindicated, a combination of angiotensin-converting-enzyme (ACE) inhibitors and diuretics is the preferred therapy in these patients. A target blood pressure below 140/90mmHg for non-diabetic patients, below 130mmHg/80mmHg for diabetic patients and below 125mmHg/75mmHg for those with renal disease and proteinuria (≥ 1 gram per day) should be reached. Lifestyle interventions may be as effective as medication and should be used in conjunction with medical management. Waist circumference should be less than 102cm for men and 88cm for women. There remains uncertainty about the management of high blood pressure in the context of acute stroke. Conclusions: A combination of ACE-inhibitors and diuretics is recommended in hypertensive stroke patients. Blood pressure should be maintained below 140/90 mmHg.

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