Level of blood pressure for stroke
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Optimal Blood Pressure Levels for Stroke Prevention
Introduction to Blood Pressure and Stroke Risk
Stroke is a leading cause of death and disability worldwide, with high blood pressure (BP) being the most significant modifiable risk factor. The relationship between BP levels and stroke risk is well-documented, with both elevated and excessively low BP levels contributing to increased stroke risk 125.
Ideal Systolic Blood Pressure for Stroke Prevention
Findings from the China Stroke Primary Prevention Trial (CSPPT)
The CSPPT study investigated the optimal systolic blood pressure (SBP) levels for preventing the first stroke in hypertensive adults. The study found that maintaining an SBP between 120 to 130 mm Hg was associated with the lowest risk of first stroke. Both higher SBP levels (130-140 mm Hg) and lower SBP levels (<120 mm Hg) were linked to increased stroke risk. Specifically, an SBP of 130-135 mm Hg and 135-140 mm Hg increased stroke risk by 63% and 85%, respectively, compared to the 120-130 mm Hg range. Conversely, an SBP below 120 mm Hg increased stroke risk by 337% .
Blood Pressure Control in Acute Stroke
In acute stroke scenarios, managing BP is crucial yet challenging. Elevated SBP levels (≥160 mm Hg) are common and can complicate treatment, while low SBP levels (≤140 mm Hg) can also increase morbidity and mortality. The optimal management strategy for BP in acute stroke remains debated, with limited data from randomized controlled trials to guide treatment 39.
Blood Pressure Targets in Recurrent Stroke Prevention
SPS3 Randomized Trial Insights
The SPS3 trial explored the effects of different BP targets on recurrent stroke rates in patients with recent lacunar stroke. The study compared a higher SBP target (130-149 mm Hg) with a lower target (<130 mm Hg). Although the reduction in stroke rates was not statistically significant, the lower target group showed a trend towards reduced stroke incidence and significantly lower rates of intracerebral hemorrhage .
Diastolic Blood Pressure and Stroke Risk
Long-term Observational Studies
Long-term studies have shown a continuous and independent association between diastolic blood pressure (DBP) and stroke risk. Lower DBP levels are consistently linked to reduced stroke risk, with no evidence of a threshold below which further reductions do not confer additional benefits. Prolonged differences in DBP of 5-10 mm Hg are associated with significant reductions in stroke risk 67.
Blood Pressure Management in Acute Ischemic Stroke and Intracerebral Hemorrhage
European Stroke Organisation (ESO) Guidelines
The ESO guidelines recommend early and modest BP control in acute ischemic stroke (AIS) patients undergoing reperfusion therapies, avoiding levels above 180/105 mm Hg. For acute intracerebral hemorrhage (ICH), intensive BP lowering is advised to improve recovery by reducing hematoma expansion. These recommendations are based on evidence from randomized controlled trials, although the quality of evidence varies .
Conclusion
Maintaining optimal BP levels is critical for stroke prevention. For primary prevention, an SBP range of 120-130 mm Hg is ideal, while both higher and lower levels increase stroke risk. In acute stroke management, careful BP control is essential, with specific targets varying based on the type of stroke and treatment approach. Continuous research and clinical trials are necessary to refine these guidelines and improve patient outcomes.
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