Vnitr Lek 1996, 42(6):426-431

[Treatment of hypertension in primary and secondary prevention of cerebrovascular stroke].

J Widimský: Klinika kardiologie IKEM, Praha.

Treatment of hypertension plays a key role in primary prevention of cerebrovascular attacks. Meta-analysis of 17 prospective studies of the treatment of hypertension proved that reduction of the systolic and diastolic blood pressure by 8-10/5-6 mmHg leads to a reduction of fatal and non-fatal cerebrovascular attacks by 40%. In the nineties a Swedish and British investigation of systolic-diastolic hypertension in elderly subjects-STOP and MRC-provided evidence of the great impact of treatment of hypertension in primary prevention of cerebrovascular attacks also in elderly hypertensive subjects (60-80 years). It is important to treat also in advanced age frequent isolated systolic hypertension as this improves markedly the prognosis of these patients and reduces the incidence of cerebrovascular and coronary complications, as was proved by the American study SHEP. The authors demonstrate that so far only the minority of hypertensive patients is treated effectively in this country and data from abroad indicate also that treatment of hypertension is lacking in the premorbid stage in more than half the patients with a cerebrovascular attack. The drugs of choice in treatment of hypertension in the elderly are small doses of thiazide diuretics and cardioselective beta-blockers or beta-blockers with ISA. By increasing the number of treated hypertensive patients, incl. elderly patients with a hypertension, and by increasing the effectiveness of treatment it is possible to achieve a decline of the cerebrovascular mortality; our objective must be a decline of the cerebrovascular mortality by more than 50%, similarly as it happened already in the USA. Conversely the importance of treatment of hypertension in secondary prevention of cerebrovascular attacks is controversial. The authors emphasize also the importance of abstinence from smoking as well as careful treatment of diabetes and hyperlipidaemia. Antiaggregation treatment has a greater impact in secondary prevention than treatment of hypertension. As regards the latter it should suffice to reduce the blood pressure to values of cca 150-160/90 -100 mmHg and not to normal values.