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Antihypertensive therapy to prevent recurrent stroke or transient ischemic attack

Norman M Kaplan, MD
Raymond R Townsend, MD
Section Editors
George L Bakris, MD
Scott E Kasner, MD
Deputy Editors
John P Forman, MD, MSc
John F Dashe, MD, PhD


Hypertension is a major risk factor for stroke and transient ischemic attack (TIA), with the risk increasing with every rise in systolic blood pressure [1]. The cardiovascular risk can be minimized by persistent correction of the hypertension [2]. (See "Overview of primary prevention of coronary heart disease and stroke", section on 'Hypertension control'.)

Once the stroke has stabilized, antihypertensive therapy can reduce the rate of recurrent stroke, independent of the baseline blood pressure. (See 'Trials of long-term antihypertensive therapy' below.)

This topic will review the long-term role of antihypertensive therapy for prevention of a recurrent stroke. The major randomized trials will be reviewed followed by discussions of specific issues, such as when to lower the blood pressure, the choice of antihypertensive drugs, the blood pressure goal in relation to the presence or absence of large artery stenosis, and the rate of blood pressure reduction.

The approach is determined by the degree of hypertension and by the type of stroke that is present: thromboembolic stroke; or intracerebral or subarachnoid hemorrhage. The diagnosis of stroke subtypes and risk factor reduction for the secondary prevention of stroke other than blood pressure control are discussed separately. (See "Clinical diagnosis of stroke subtypes" and "Overview of secondary prevention of ischemic stroke".)

Acute stroke — Treatment of hypertension may be an immediate concern in patients with an acute ischemic stroke and those with a subarachnoid or intracerebral hemorrhage. Blood pressure management in the acute phase of stroke is different from chronic therapy and is discussed in detail elsewhere. (See "Initial assessment and management of acute stroke", section on 'Blood pressure management' and "Spontaneous intracerebral hemorrhage: Treatment and prognosis", section on 'Blood pressure' and "Treatment of aneurysmal subarachnoid hemorrhage", section on 'Intracranial pressure'.)

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Literature review current through: Nov 2017. | This topic last updated: Mar 21, 2016.
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