Blood pressure reduction in secondary stroke prevention.

PURPOSE OF REVIEW: : Risk factor modification plays an important role in recurrent stroke prevention. These modifiable risk factors tend to cluster in stroke patients, but for a significant subgroup the only identifiable risk factor is high blood pressure or chronic hypertension. This article reviews the current evidence for management of blood pressure in secondary stroke prevention. RECENT FINDINGS: : Over the years, data from primary prevention trials have shown that antihypertensive drug treatment reduces the risk of first stroke by 32%. Similarly, various secondary prevention studies have shown a relative risk reduction in recurrent strokes of up to 30%. These trials have also shown that the impact of blood pressure reduction in stroke prevention is similar in patients with hypertension and patients without hypertension, and larger reductions in systolic blood pressure were associated with greater reduction in risk of recurrent stroke. SUMMARY: : Although it is clear from the current evidence that long-term blood pressure control is one of the most important interventions for secondary stroke prevention, the optimal management of blood pressure in the immediate poststroke period is not well defined.