Stroke is a leading cause of death and disability worldwide, and this stroke is the most common type of stroke, accounting for about 85% of all cases. 

The main goal of stroke management is to prevent further neurological damage and improve functional outcomes. 

Intensive blood pressure (BP) lowering has been shown to be a promising strategy for reducing the risk of recurrent stroke and improving outcome in patients with ischemic stroke.

Ischemic stroke is caused by a blood clot that obstructs the blood flow to the brain, leading to a lack of oxygen and nutrients, which can cause injury to the brain. 

High blood pressure is one of the leading modifiable risk factors for ischemic stroke, and BP control is essential to reduce the risk of recurrent stroke. 

The American Heart Association (AHA) recommends that BP should be lowered to less than 140/90 mmHg in most patients with a history of stroke. 

However, recent studies have shown that intensive BP lowering to a target of less than 120 mmHg systolic can be more effective in reducing the risk of recurrent stroke in some patients.

Intensive BP lowering can be achieved with a combination of lifestyle modifications, such as a low-salt diet, physical activity, and weight loss, and pharmacotherapy, including diuretics, ACE inhibitors, calcium channel blockers, and others. 

The choice of drug therapy should be individualized based on the patient’s comorbidities, age, and preferences.

The SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial was one of the first studies to demonstrate the benefits of intensive BP lowering in patients with ischemic stroke. 

The study enrolled patients with a history of ischemic stroke and high-risk lipid profiles and assigned them to either atorvastatin (80 mg/day) or placebo. 

The study showed that intensive BP lowering reduced the risk of recurrent stroke by 16% and improved outcome in patients with ischemic stroke.

Another important study was the INTERACT2 (Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2), which investigated the effect of intensive BP lowering in patients with acute ischemic stroke. 

The study showed that intensive BP lowering reduced the risk of death and major disability by nearly 25% in patients with acute ischemic stroke.

The results of these studies have led to a change in clinical practice, with more and more physicians recommending intensive BP lowering for patients with ischemic stroke. 

However, it is important to note that intensive BP lowering may not be appropriate for all patients, and individualized decision making is essential. 

For example, patients with a history of intracerebral hemorrhage or severe hypoperfusion may be at increased risk for further brain injury with intensive BP lowering.

Conclusion

Intensive BP lowering is a promising strategy for reducing the risk of recurrent stroke and improving outcome in patients with ischemic stroke. 

However, the decision to initiate intensive BP lowering should be based on a careful evaluation of the patient’s individual risk factors and comorbidities. 

Patients with ischemic stroke should work closely with their healthcare provider to develop an individualized treatment plan that takes into account their unique needs and goals.

Visit DocMode for Courses and lectures