Primary and secondary prevention of stroke by antihypertensive drug treatment.Expert Rev Neurother. 2004 Nov; 4(6):1023-31.ER
Hypertension is the most powerful risk factor for stroke. Antihypertensive drug treatment reduces the incidence of stroke. In a meta-analysis of actively controlled trials, calcium-channel blockers, including (-8%; p = 0.07) or excluding verapamil (-10%; p = 0.02), as well as angiotensin Type 1 receptor blockers (-24%; p = 0.0002) resulted in better stroke prevention than the old drugs (diuretics or beta-blockers), whereas the opposite trend was observed for angiotensin-converting enzyme inhibitors (+10%; p = 0.03). An overview of six trials conducted in patients with a history of cerebrovascular disease demonstrated that blood pressure-lowering therapy reduced stroke recurrence by 25% (p = 0.004). A meta-regression analysis showed that within-trial differences in systolic blood pressure accounted for the prevention of stroke in most trials. This finding was corroborated by the recently published Valsartan Antihypertensive Long-term Use Evaluation trial.