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Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence.

Abstract

BACKGROUND AND OBJECTIVES

It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke.

RESULTS

A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak.

CONCLUSION

A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.

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  • Authors+Show Affiliations

    ,

    aIstituto Auxologico Italiano bUniversità di Milano, Milan, Italy cFuWai Hospital and Cardiovascular Institute dBeijing Hypertension League Institute, Beijing, China eUniversità Milano-Bicocca fIRCCS Multimedica, Sesto San Giovanni, Milan, Italy gOslo University Hospital, Oslo, Norway hUniversity of Valencia, Madrid, Spain iMedical University of Gdansk, Gdansk, Poland jUniversity of Glasgow, Glasgow, UK kLund University, Scania University Hospital, Malmo, Sweden lTallinn University of Technology, Tallinn, Estonia mEuropean Hospital Georges Pompidou, Paris, France nUniversità di Brescia, Spedali Civili, Brescia, Italy oBeijing Anzhen Hospital, Beijing pShanghai Hypertension Institute, Shanghai, China qComplutense University rHospital 12 de Octubre sHospital Clínico San Carlos, Madrid, Spain tCentro Hospitalar de Entre o Douro e Vouga, E.P.E., Portugal uNephrology and Hypertension, University Hospital, Erlangen, Germany vUniversity Hospital of Lausanne, Lausanne, Switzerland wMedical University of Lodz, Lodz, Poland xCharles University Medical School I and Thomayer Hospital, Prague, Czech Republic ySt. Imre University Teaching Hospital, Budapest, Hungary zAlmazov Federal Heart, Blood and Endocrinology Center, St. Petersburg, Russia aaRSPC Cardiology, Minsk, Belarus abNSC 'Institute of Cardiology named after N.D. Strazhesko' of NAMS, Kiev, Ukraine acEmergency Hospital of Bucharest, Bucharest, Romania adUniversity Hospital Saint Anna, Sofia, Bulgaria aeDr Peter Drzai Hospital, Ljubljana, Slovenia afUniversity Hospital Center Zagreb, Zagreb, Croatia agClinic for Internal Medicine InterMedic, Nis, Serbia ahCardiology Department, Asklepeion General Hospital, Athens, Greece aiNicosia General Hospital, Nicosia, Cyprus ajIstanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey akHasharon Hospital - Rabin Medical Center, Petach-Tikva, Israel alBeijing Xuanwu Hospital amSecond Affiliate Hospital, Beijing University anMilitary General Hospital, Beijing, China aoH

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    Source

    Journal of hypertension 32:9 2014 Sep pg 1741-50

    MeSH

    Blood Pressure
    Cholesterol
    Cholesterol, LDL
    Cognition
    Cognition Disorders
    Humans
    Hypercholesterolemia
    Male
    Primary Prevention
    Randomized Controlled Trials as Topic
    Recurrence
    Secondary Prevention
    Stroke

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    24979302

    Citation

    Zanchetti, Alberto, et al. "Blood Pressure and Low-density Lipoprotein-cholesterol Lowering for Prevention of Strokes and Cognitive Decline: a Review of Available Trial Evidence." Journal of Hypertension, vol. 32, no. 9, 2014, pp. 1741-50.
    Zanchetti A, Liu L, Mancia G, et al. Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence. J Hypertens. 2014;32(9):1741-50.
    Zanchetti, A., Liu, L., Mancia, G., Parati, G., Grassi, G., Stramba-Badiale, M., ... Ford, G. (2014). Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence. Journal of Hypertension, 32(9), pp. 1741-50. doi:10.1097/HJH.0000000000000253.
    Zanchetti A, et al. Blood Pressure and Low-density Lipoprotein-cholesterol Lowering for Prevention of Strokes and Cognitive Decline: a Review of Available Trial Evidence. J Hypertens. 2014;32(9):1741-50. PubMed PMID: 24979302.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence. AU - Zanchetti,Alberto, AU - Liu,Lisheng, AU - Mancia,Giuseppe, AU - Parati,Gianfranco, AU - Grassi,Guido, AU - Stramba-Badiale,Marco, AU - Silani,Vincenzo, AU - Bilo,Grzegorz, AU - Corrao,Giovanni, AU - Zambon,Antonella, AU - Scotti,Lorenza, AU - Zhang,Xinhua, AU - Wang,HayYan, AU - Zhang,Yuqing, AU - Zhang,Xuezhong, AU - Guan,Ting Rui, AU - Berge,Eivind, AU - Redon,Josep, AU - Narkiewicz,Krzysztof, AU - Dominiczak,Anna, AU - Nilsson,Peter, AU - Viigimaa,Margus, AU - Laurent,Stéphane, AU - Agabiti-Rosei,Enrico, AU - Wu,Zhaosu, AU - Zhu,Dingliang, AU - Rodicio,José Luis, AU - Ruilope,Luis Miguel, AU - Martell-Claros,Nieves, AU - Pinto,Fernando, AU - Schmieder,Roland E, AU - Burnier,Michel, AU - Banach,Maciej, AU - Cifkova,Renata, AU - Farsang,Csaba, AU - Konradi,Alexandra, AU - Lazareva,Irina, AU - Sirenko,Yuriy, AU - Dorobantu,Maria, AU - Postadzhiyan,Arman, AU - Accetto,Rok, AU - Jelakovic,Bojan, AU - Lovic,Dragan, AU - Manolis,Athanasios J, AU - Stylianou,Philippos, AU - Erdine,Serap, AU - Dicker,Dror, AU - Wei,Gangzhi, AU - Xu,Chengbin, AU - Xie,Hengge, AU - Coca,Antonio, AU - O'Brien,John, AU - Ford,Gary, PY - 2014/7/1/entrez PY - 2014/7/1/pubmed PY - 2015/11/17/medline SP - 1741 EP - 50 JF - Journal of hypertension JO - J. Hypertens. VL - 32 IS - 9 N2 - BACKGROUND AND OBJECTIVES: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke. RESULTS: A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak. CONCLUSION: A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline. SN - 1473-5598 UR - https://www.unboundmedicine.com/medline/citation/24979302/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=24979302 DB - PRIME DP - Unbound Medicine ER -