The role of arterial hypertension in the primary prevention of stroke

Hypertension belongs to the most important modifiable risk factors of cerebrovascular diseases and stroke. Home or 24-hour ambulatory blood pressure measurement (ABPM) is a preferable measurement of blood pressure. Nonpharmacologic treatment should include smoking abstinence, overweight reduction, restriction of alcohol intake and moderate consumption of salt.Evidence based clinical studies have convincingly proved that drug therapy decreases the incidence of cerebrovascular diseases and stroke by 40–60%. Systolic blood pressure is more important than diastolic blood pressure in the elderly patients, in whom the majority of cerebrovascular diseases and strokes occur.A great discussion concentrates on the issue of goal values of blood pressure in the prevention of cerebrovascular diseases and stroke. Unfortunately all evidence based studies were performed only in patients with initial systolic blood pressure of 160 mm Hg and more.Only 2 studies focused on the target systolic blood pressure in the stroke prevention. The ACCORD study compared target values of 120 and 140 mm Hg. Target systolic pressure 120 mm Hg was superior (over 140 mm Hg) in stroke prevention, but not in prevention of other cardiovascular events (myocardial infarction or heart failure).The recent SPRINT study found a decrease of total mortality in patients with target systolic blood pressure of 120 mm Hg over those with 140 mm Hg target. From the above mentioned studies it seems that the lower systolic blood pressure is preferable.