doi: 10.1161/01.STR.0000115162.16321.AA
(Stroke. 2004;35:348.)
© 2004 American Heart Association, Inc.
Advances in Stroke 2003 |
Hypertension, Angiotensin, and Stroke: Beyond Blood Pressure
From the Division of Neurobiology (C.I.), Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY; and Stroke Service (P.B.G.), Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, Ill.
Correspondence to C. Iadecola, MD, Division of Neurobiology, Weill Medical College of Cornell University, 411 East 69th St, KB410, New York, NY 10021. E-mail coi2001@med.cornell.edu
Key Words: Advances in Stroke • angiotensins • hypertension • stroke
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Hypertension (HTN) is a major risk factor for all stroke subtypes, infarction as well as hemorrhage.1,2 Evidence from clinical trials shows that control of blood pressure (BP) leads to a substantially lower risk of stroke.3 HTN exerts detrimental actions on the cerebral circulation that play a critical role in its ability to promote cerebrovascular diseases. Angiotensin II (Ang II) is a key mediator by which HTN exerts its deleterious vascular effects. Recent findings raise the possibility that some of the detrimental actions of Ang II are independent of the associated elevation in BP. Here we will discuss the effect of HTN on stroke in light of recent advances indicating that the renin angiotensin system (RAS) may a play a role greater than previously believed in the deleterious cerebrovascular actions of HTN and, as such, is a promising target for stroke prevention.
Hypertension Is a Major Risk Factor for Stroke
HTN is the most prevalent and powerful modifiable risk factor for stroke, irrespective of geographic region and ethnic group.1,4 Persons with HTN are about 3 or 4 times more likely to have a stroke.2 Whereas diastolic BP was once thought to be the most important predictor of stroke, the relationship between stroke and HTN may be stronger for systolic than for diastolic BP.5 The association between BP and stroke risk seems to occur on a continuum rather than as a threshold effect.6 The majority of strokes have been reported among persons with only "borderline" or "mild" HTN, and both persons classified as "hypertensive" as well as "normotensive" may benefit
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