Prevention of Second Strokes Through Blood Pressure Lowering: Update for 2011

Hypertension has long been recognized as a major risk factor for stroke, and lowering blood pressure has been shown to be effective in preventing first-time strokes. However, it is only over the past decade or so that lowering blood pressure has been shown to also be effective in preventing recurrent strokes. Large recent studies have quantified the effect of blood pressure lowering on stroke prevention, and increasing attention is being paid to variability of blood pressure rather than usual blood pressure values in determining stroke risk and explaining some of the class differences between various antihypertensives in stroke prevention. On the flip side, however, large trials aimed at showing a benefit of angiotensin receptor blockers on stroke prevention, above and beyond blood pressure lowering, have not yielded positive results. Many important questions such as the optimal time to initiate antihypertensive treatment after a stroke, the choice of the antihypertensive agent, and the optimal blood pressure goal after a stroke remain to be determined.