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Special Issue: Current evidence and perspectives for hypertension management in Asia

Blood pressure management for secondary stroke prevention

Abstract

Hypertension is the most important vascular risk factor for stroke; therefore, optimal blood pressure (BP) management is essential for the prevention of recurrent stroke; lowering BP was shown to reduce the risk of recurrent stroke by 25–30%. A recent meta-analysis showed that intensive BP lowering to levels <130/80 mmHg significantly reduced the risk of recurrent stroke compared to standard management with BP levels <140/90 mmHg. The benefit of intensive BP management is evident with regard to a reduced risk of intracranial hemorrhage. Therefore, clinical practice guidelines have established a target BP of <130/80 mmHg. However, the target BP needs to be individualized. A stepped-care approach for cautious BP lowering (usually to levels <140/90 mmHg) is preferred for patients with severe diseases of the major cerebral vessels, who have a high risk of recurrent ischemic stroke. In contrast, more aggressive BP lowering (to levels <120/80 mmHg) tends to benefit patients at high risk of intracranial hemorrhage. The selection of BP management strategies should be guided by the risk of recurrent ischemic and hemorrhagic strokes.

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Correspondence to Kazuo Kitagawa.

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KK reports grants and personal fees from Daiichi Sankyo, Bayer Inc., grants and personal fees from Nippon Boehringer Ingelheim, Kyowa Kirin, Sumitomo Dainippon Pharma, Astellas Pharma, and Sanofi, and personal fees from Takeda Pharmaceutical outside of the submitted work.

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Kitagawa, K. Blood pressure management for secondary stroke prevention. Hypertens Res 45, 936–943 (2022). https://doi.org/10.1038/s41440-022-00908-1

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  • DOI: https://doi.org/10.1038/s41440-022-00908-1

Keywords

  • Stroke
  • Blood pressure lowering
  • Intensive blood pressure control
  • Ischemic stroke
  • Hemorrhagic stroke

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