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(Stroke. 2006;37:317.)
© 2006 American Heart Association, Inc.

Advances in Stroke 2005

Advances in Primary Stroke Prevention

From the Department of Medicine (Neurology), Duke Center for Cerebrovascular Disease, Center for Clinical Health Policy Research, Duke University and Veterans Affairs Medical Center, Durham, NC (L.B.G.); and the Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia, School of Medicine and Pharmacology, University of Western Australia (G.J.H.).

Correspondence to Larry B. Goldstein, MD, Box 3651, Duke Medical Center, Durham, NC 27710. E-mail golds004@mc.duke.edu

Key Words: aspirin • atrial fibrillation • hormone replacement therapy • hypertension • prevention & control • statins • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Because 75% of strokes are first-ever strokes,¹ it is likely that effective prevention in persons with established risk factors who have not had a stroke (ie, primary prevention) can have as great or a greater impact on reducing the burden of the disease as effective prevention of recurrent stroke. The cost associated with inadequate primary prevention is at least as great as that resulting from inadequate secondary prevention.² There were several important studies published over the last year providing new data addressing primary stroke prevention.

Blood Pressure–Lowering

Lowering systolic blood pressure by 10 mm Hg is associated with a reduction in the risk of stroke by about one third, irrespective of baseline blood pressure (BP) levels.³ It remains uncertain whether long-acting dihydropridine calcium-channel blockers (CCBs), angiotensin-converting enzyme inhibitors, or angiotensin II receptor blocker (ARBs) are more effective than other classes of antihypertensive drugs, and whether the very elderly benefit from treatment.

The Anglo-Scandinavian Cardiac Outcomes Trial–Blood pressure Lowering Arm (ASCOT-BPLA) randomly allocated 19 257 individuals aged 40 to 79 years with hypertension and at least 3 other cardiovascular risk factors to an amlopidine-based (amlodipine 5 to 10 mg adding perindopril 4 to 8 mg as required) as compared with an atenolol-based drug regimen (atenolol 50 to 100 mg adding bendroflumethiazide 1.25 to 2.5 mg and potassium as required).⁴ After 5.5 years median follow-up, the amlopidine-based regimen was associated with lower rates of stroke (hazard ratio [HR]=0.77, 95% CI: 0.66 to 0.89), coronary events (HR=0.86, 95% CI: 0.77 to 0.96) and new-onset diabetes . . . [Full Text of this Article]

This article has been cited by other articles:

				L. B. Goldstein and P. M. Rothwell Advances in Primary Prevention and Health Services Delivery Stroke, May 1, 2009; 40(5): e295 - e297. [Full Text] [PDF]