[Treatment of arterial hypertension after ischemic cerebral stroke]

Abstract

Lethality associated with secondary cerebral stroke is higher than in primary one. Data on the clinical course of arterial hypertension after stroke are contradictory. In recent years, the risk of a repeated ischemic stroke has been considered to be in a direct correlation with both systolic and diastolic blood pressure (BP), while the optimal BP level differs depending on the type of the stroke. Lowering BP should not exceed the ability of brain flow autoregulation to maintain normal cerebral perfusion. Data on the effectiveness of different groups of antihypertensive drugs in terms of secondary stroke prevention are contradictory. It has been reported that the risk of a secondary cerebral stroke lowered depending on the degree of BP decrease. At the same time, various antihypertensive drug classes were directly compared only in MOSES study. As far as secondary stroke prevention is concerned, differences between these classes suggest the existence of other than hypotensive mechanisms of their action. The presence of carotid atherosclerosis may compromise cerebral perfusion and predispose the patient to a second stroke, when a hypotensive effect is achieved.