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(Stroke. 2003;34:1333.)
© 2003 American Heart Association, Inc.

Controversies in Stroke

Blood Pressure–Lowering for Secondary Prevention of Stroke: ACE Inhibition Is the Key

From the Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand.

Correspondence to Prof Craig S. Anderson, Clinical Trials Research Unit, University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail c.anderson@ctru.auckland.ac.nz

Key Words: angiotensin-converting enzyme inhibitors • blood pressure • stroke prevention

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

Angiotensin-converting enzyme (ACE) inhibitors undoubtedly represent one of the major advances in cardiovascular therapeutics over the past 20 years. Having been originally derived from the venom of the Brazilian arboreal viper Bothrops jararaca, captopril and subsequent ACE inhibitors are currently well-established agents for the treatment of patients with hypertension, heart failure, and left ventricular dysfunction. They have also been shown to reduce the risk of major vascular events and progression of renal disease in patients with diabetes and proteinuria, while the Heart Outcomes Protection Evaluation (HOPE)¹ study demonstrated benefits of ramipril in patients with coronary artery disease and preserved left ventricular function. Most recently, the Perindopril Protection Against Recurrent Stroke Study (PROGRESS)² showed that an ACE inhibitor (perindopril)–based therapy reduced the risks of both ischemic and hemorrhagic stroke in patients with established cerebrovascular disease. Moreover, the benefits of treatment were consistent across different patient subgroups, such as those with and without a history of hypertension (or high blood pressure [BP] at entry), ischemic subtypes and intracerebral hemorrhage, and ethnicity (Asian versus non-Asian), and occurred on a background of other therapies. The evidence is, therefore, strong for ACE inhibitors being pivotal to the primary and secondary prevention of cardiovascular disease across a broad range of "high-risk" individuals. The therapy is particularly relevant to patients with stroke, given that the absolute risks of recurrent stroke and other vascular events are very high, and the treatment is now proven to be safe, well tolerated, applicable across all major stroke subtypes, and it . . . [Full Text of this Article]