Stroke and blood pressure levels
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Stroke and Blood Pressure Levels: A Comprehensive Overview
Introduction: Stroke and Hypertension
Stroke is a leading cause of death and disability worldwide, with hypertension being the most significant modifiable risk factor. Elevated blood pressure (BP) is associated with a substantial increase in stroke risk, making BP management crucial for both the prevention and treatment of stroke .
Blood Pressure and Stroke Risk
Hypertension as a Primary Risk Factor
Research indicates that the risk of stroke increases significantly at BP levels above 115/75 mm Hg. High BP is linked to 54% of stroke episodes globally, emphasizing the importance of BP control in stroke prevention. Studies show that antihypertensive therapy can substantially reduce the risk of all types of stroke, stroke-related death, and disability .
Optimal BP Levels for Stroke Prevention
The China Stroke Primary Prevention Trial (CSPPT) found that maintaining systolic BP (SBP) between 120 to 130 mm Hg is optimal for reducing the risk of first stroke. Both higher and lower SBP levels were associated with increased stroke risk, following a U-shaped curve. This suggests that both elevated and excessively low BP can be detrimental.
Blood Pressure Management in Acute Stroke
Elevated BP in Acute Stroke
Elevated systolic BP (≥160 mm Hg) is common in acute stroke, affecting up to 60% of patients. This presents a management challenge, especially for those already on antihypertensive therapy. High BP in acute stroke is associated with poor outcomes, including increased mortality and morbidity .
BP Levels and Clinical Outcomes
A systematic review and meta-analysis of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) revealed that higher pre- and post-treatment SBP levels are linked to worse outcomes, including increased mortality and symptomatic intracranial hemorrhage (sICH). Conversely, lower post-treatment SBP levels were associated with better functional independence at three months.
Long-Term BP Control and Stroke Prevention
Benefits of BP Reduction
Long-term studies indicate that a reduction in BP can significantly lower the risk of stroke. For instance, a prolonged difference in usual BP levels of just 9/5 mm Hg is associated with approximately a one-third reduction in stroke risk . This effect is consistent across different populations and age groups, including those aged 80 years and older.
Treatment Strategies
Randomized controlled trials have shown that antihypertensive treatment can achieve much of the long-term stroke prevention potential within a few years of starting therapy. A net reduction of 10-12 mm Hg in systolic BP and 5-6 mm Hg in diastolic BP can reduce stroke incidence by 38%. The choice of antihypertensive agent appears less critical than achieving and maintaining BP reduction.
Conclusion
Effective management of blood pressure is crucial for both the prevention and treatment of stroke. Optimal BP levels for stroke prevention lie within a narrow range, and both elevated and excessively low BP can increase stroke risk. In acute stroke, careful BP management is essential to improve outcomes. Long-term BP control through antihypertensive therapy significantly reduces stroke risk, underscoring the importance of sustained BP management in stroke prevention strategies.
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