Effect of antihypertensive treatment in patients having already suffered from stroke - Gathering the evidence

被引:190
作者
Gueyffier, F
Boissel, JP
Boutitie, F
Pocock, S
Coope, J
Cutler, J
Ekbom, T
Fagard, R
Friedman, L
Kerlikowske, K
Perry, M
Prineas, R
Schron, E
机构
[1] UNIV LYON 1, LYON HOSP, DEPT CLIN PHARMACOL, LYON, FRANCE
[2] UNIV LONDON LONDON SCH HYG & TROP MED, LONDON WC1E 7HT, ENGLAND
[3] NHLBI, BETHESDA, MD 20892 USA
[4] HYPERTENS & CARDIOVASC REHABIL UNIT, LOUVAIN, BELGIUM
[5] VET ADM MED CTR, SAN FRANCISCO, CA 94121 USA
[6] DEPT COMMUNITY HLTH SCI, DALBY, LUND, SWEDEN
[7] UNIV MIAMI, SCH MED, DEPT EPIDEMIOL & PUBL HLTH, MIAMI, FL USA
[8] WASHINGTON UNIV, SCH MED, ST LOUIS, MO USA
关键词
antihypertensive agents; clinical trials; hypertension; meta-analysis; stroke prevention;
D O I
10.1161/01.STR.28.12.2557
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:2557 / 2562
页数:6
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