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(Stroke. 1997;28:2557-2562.)
© 1997 American Heart Association, Inc.
Articles |
Effect of Antihypertensive Treatment in Patients Having Already Suffered From Stroke
Gathering the Evidence
From the Clinical Pharmacology Department (F.G., J-P.B, F.B.), Claude Bernard University, Lyon Hospitals, France; London School of Hygiene and Tropical Medicine (S.P.), London, UK; General practice (J.C.), Bollington, UK; National Heart, Lung, and Blood Institute (J.C., L.F., E.S.), National Institutes of Health, Bethesda, MD; Department of Community Health Sciences (T.E.), Dalby/Lund, Sweden; Hypertension and Cardiovascular Rehabilitation Unit (R.F.), Leuven, Belgium; Veterans Administration Medical Center (K.K.), San Francisco, Calif; Washington University School of Medicine (M.P.), St Louis, MO; and Department of Epidemiology and Public Health (R.P.), Miami, Fla.
Correspondence to Dr François Gueyffier, Service de Pharmacologie Clinique - 162 Avenue Lacassagne - BP 3041, 69 394 LYON Cedex 03, France. E-mail fg{at}upcl.univ-lyon1.fr
Background and Purpose Drug treatment of high blood pressure has been shown to reduce the associated cardiovascular risk. Stroke represents the type of event more strongly linked with high blood pressure, responsible for a high rate of death or invalidity, and with the highest proportion of events that can be avoided by treatment. Hypertensive patients with a history of cerebrovascular accident are at particularly high risk of recurrence. Specific trials of blood pressure lowering drugs in stroke survivors showed inconclusive results in the past.
Methods We performed a meta-analysis using all available randomized controlled clinical trials assessing the effect of blood pressure lowering drugs on clinical outcomes (recurrence of stroke, coronary events, cause-specific, and overall mortality) in patients with prior stroke or transient ischemic attack.
Results We identified 9 trials, including a total of 6752 patients: 2 trials included 551 hypertensive stroke survivors; 6 trials of hypertensive patients included a small proportion of stroke survivors (536 patients); 1 trial included stroke survivors, whether hypertensive or not (5665 patients). The recurrence of stroke, fatal and nonfatal, was significantly reduced in active groups compared with control groups consistently across the different sources of data (relative risk of 0.72, 95% confidence interval: 0.61 to 0.85). There was no evidence that this intervention induced serious adverse effect.
Conclusions Blood pressure lowering drug interventions reduced the risk of stroke recurrence in stroke survivors. Available data did not allow to verify whether such benefit depends on initial blood pressure level. More data are needed before considering antihypertensive therapy in normotensive patients at high cerebrovascular risk.
Key Words: antihypertensive agents • clinical trials • hypertension • meta-analysis • stroke prevention
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