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Antihypertensive treatment and stroke prevention: are angiotensin receptor blockers superior to other antihypertensive agents?
Ther Adv Cardiovasc Dis. 2009 Jun; 3(3):197-204.TA

Abstract

Stroke remains a common vascular event with high mortality and morbidity. After heart disease, stroke is the second leading cause of death worldwide in adult persons. Silent or subclinical stroke is likely to occur with even greater frequency than clinical stroke and increases the risk of subsequent cerebrovascular events. Hypertension is by far the single most important controllable risk factor for stroke. The relationship between blood pressure (BP) and stroke mortality is strong, linear, and continuous in subjects with levels of BP higher than 115/75 mm Hg. Blood pressure reduction by antihypertensive treatment is clearly efficacious in the prevention of stroke (both primary and secondary). Although meta-analyses suggest that BP reduction, per se, is the most important determinant for stroke risk reduction, the question is if specific classes of antihypertensive drugs offer special protection against stroke is still controversial. Some studies have suggested that angiotensin receptors blockers (ARBs) appear to offer additional protection against stroke. This has been hypothesized in studies in hypertensives, such as LIFE and SCOPE, and especially in the only comparative trial focused on secondary stroke prevention. In the MOSES trial, the comparison of eprosartan versus nitrendipine in patients with a previous stroke resulted, despite a similar BP reduction, in a significant reduction in the primary composite endpoint of total mortality plus cardiovascular and cerebrovascular events, including recurrent events. These results may suggest a blood pressure-independent effect of ARBs, which can be mediated through several mechanisms, including their ability to counteract other markers of target organ damage, but also through a direct neuroprotective effect.

Authors+Show Affiliations

Unit of Hypertension and Vascular Risk, Department of Internal Medicine, Hospital General de L'Hospitalet, University of Barcelona, Spain.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

19443514

Citation

Armario, Pedro, and Alejandro de la Sierra. "Antihypertensive Treatment and Stroke Prevention: Are Angiotensin Receptor Blockers Superior to Other Antihypertensive Agents?" Therapeutic Advances in Cardiovascular Disease, vol. 3, no. 3, 2009, pp. 197-204.
Armario P, de la Sierra A. Antihypertensive treatment and stroke prevention: are angiotensin receptor blockers superior to other antihypertensive agents? Ther Adv Cardiovasc Dis. 2009;3(3):197-204.
Armario, P., & de la Sierra, A. (2009). Antihypertensive treatment and stroke prevention: are angiotensin receptor blockers superior to other antihypertensive agents? Therapeutic Advances in Cardiovascular Disease, 3(3), 197-204. https://doi.org/10.1177/1753944709104164
Armario P, de la Sierra A. Antihypertensive Treatment and Stroke Prevention: Are Angiotensin Receptor Blockers Superior to Other Antihypertensive Agents. Ther Adv Cardiovasc Dis. 2009;3(3):197-204. PubMed PMID: 19443514.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antihypertensive treatment and stroke prevention: are angiotensin receptor blockers superior to other antihypertensive agents? AU - Armario,Pedro, AU - de la Sierra,Alejandro, Y1 - 2009/05/14/ PY - 2009/5/16/entrez PY - 2009/5/16/pubmed PY - 2009/8/6/medline SP - 197 EP - 204 JF - Therapeutic advances in cardiovascular disease JO - Ther Adv Cardiovasc Dis VL - 3 IS - 3 N2 - Stroke remains a common vascular event with high mortality and morbidity. After heart disease, stroke is the second leading cause of death worldwide in adult persons. Silent or subclinical stroke is likely to occur with even greater frequency than clinical stroke and increases the risk of subsequent cerebrovascular events. Hypertension is by far the single most important controllable risk factor for stroke. The relationship between blood pressure (BP) and stroke mortality is strong, linear, and continuous in subjects with levels of BP higher than 115/75 mm Hg. Blood pressure reduction by antihypertensive treatment is clearly efficacious in the prevention of stroke (both primary and secondary). Although meta-analyses suggest that BP reduction, per se, is the most important determinant for stroke risk reduction, the question is if specific classes of antihypertensive drugs offer special protection against stroke is still controversial. Some studies have suggested that angiotensin receptors blockers (ARBs) appear to offer additional protection against stroke. This has been hypothesized in studies in hypertensives, such as LIFE and SCOPE, and especially in the only comparative trial focused on secondary stroke prevention. In the MOSES trial, the comparison of eprosartan versus nitrendipine in patients with a previous stroke resulted, despite a similar BP reduction, in a significant reduction in the primary composite endpoint of total mortality plus cardiovascular and cerebrovascular events, including recurrent events. These results may suggest a blood pressure-independent effect of ARBs, which can be mediated through several mechanisms, including their ability to counteract other markers of target organ damage, but also through a direct neuroprotective effect. SN - 1753-9447 UR - https://www.unboundmedicine.com/medline/citation/19443514/Antihypertensive_treatment_and_stroke_prevention:_are_angiotensin_receptor_blockers_superior_to_other_antihypertensive_agents L2 - http://journals.sagepub.com/doi/full/10.1177/1753944709104164?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -