Accepted Manuscript Lowering blood pressure to prevent stroke recurrence. A systematic review of longterm randomized trials Carlos A. Feldstein , M.D. PII:

S1933-1711(14)00552-X

DOI:

10.1016/j.jash.2014.05.002

Reference:

JASH 514

To appear in:

Journal of the American Society of Hypertension

Received Date: 21 March 2014 Revised Date:

3 May 2014

Accepted Date: 3 May 2014

Please cite this article as: Feldstein CA, Lowering blood pressure to prevent stroke recurrence. A systematic review of long-term randomized trials, Journal of the American Society of Hypertension (2014), doi: 10.1016/j.jash.2014.05.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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TITLE:

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Lowering blood pressure to prevent stroke recurrence.

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A systematic review of long-term randomized trials CARLOS A. FELDSTEIN, M.D.

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Hypertension Program, Hospital de Clínicas José de San Martín, University of Buenos Aires, Argentina

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e-mail: [email protected]

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Av. Córdoba 2351, Buenos Aires (1120), Argentina

Short Title Blood Pressure lowering and stroke recurrence Word count: 4409

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Abstract (239)

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Albeit hypertension is a leading risk factor for an initial stroke, the role of BP lowering to prevent a subsequent stroke is controversial. The present systematic review searched randomized trials published from January 1990 to January 2014 with the aim to assess antihypertensive treatment effects on recurrent stroke prevention. Seven randomized,

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placebo controlled trials enrolling 49518 patients, two randomized trials not placebo controlled comparing

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antihypertensive drugs, and one randomized trial that compared the effects of intensive systolic blood pressure lowering with a more conservative systolic blood pressure management, were identified. The placebo-controlled trials had substantial methodological differences, explaining the difficulties to compare their results. An important obstacle arises from the large dispersion in the window`s time between the qualifying stroke to randomization. Another barrier is

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the variation among studies in the recruited patient´s stroke subtypes. Differences found between the trials could not be attributed neither to disparity in lowering BP nor to distinct degrees of lack of adherence. The American Heart

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Association/American Stroke Association stated that although an absolute target of BP level has not been clearly

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defined, a reduction in recurrent stroke has been associated with an average lowering of 10/5mmHg. It should be taken into account that it is not advisable to reduce BP levels to

Lowering blood pressure to prevent stroke recurrence: a systematic review of long-term randomized trials.

Albeit hypertension is a leading risk factor for an initial stroke, the role of blood pressure (BP) lowering to prevent a subsequent stroke is controv...
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