Hypertension and dyslipidemia treament in stroke
Authors:
Barbora Nussbaumerová
Authors‘ workplace:
Centrum preventivní kardiologie, II. interní klinika LF a FN v Plzni
Published in:
Vnitř Lék 2022; 68(3): 172-177
Category:
Review Articles
Overview
Stroke is the second most common cause of mortality worldwide and the third most common cause of disability. Arterial hypertension is the most prevalent risk factor for stroke. A precise management of arterial hypertension prevents the first episode of stroke and the recurrence. Blood pressure must be decreased carefully and not very vigorously in the acute phase of the stroke. Recommended blood pressure goals in chronic tratment are at least 140 / 90 mm Hg and lower if tolerated. ACE inhibitors or angiotensin receptor blockers in combination with calcium channel blockers or indapamide are favorable antihypertensive drugs. Dyslipidemia is also a strong risk factor for ischaemic stroke and has no relatioship to the other etiologies of stroke. The cardiovascular risk in patients after a stroke is very high. An intensive hypolipidemic treatment by statins, ezetimibe and PCSK9i to LDL-cholesterol goals < 1,4 mmol/l and a 50% decrease was proved to decrease the incidence of recurrent stroke.
Keywords:
hypolipidemic drugs – stroke – secondary prevention – statin – Antihypertensive drugs – arterial hypertension – dyslipidemia – ezetimibe – PCSK9i
Sources
1. Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018; 2018: 3238165. doi: 10.1155/2018/3238165
2. Kotseva K, De Backer G, De Bacquer D. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC‑EORP EUROASPIRE V registry. European Journal of Preventive Cardiology 2019(26);8. https://doi.org/10.1177/2047487318825350
3. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J 2014;35:2950-2959.
4. Samsa GP, Bian J, Lipscomb J, Matchar DB. Epidemiology of recurrent cerebral infarction: a medicare claims‑based comparison of first and recurrent strokes on 2-year survival and cost. Stroke. 1999;30:338-349.
5. Feng W, Hendry HM, Adams RJ. Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients. Neurology 2010;74(7) DOI: https://doi.org/10.1212/WNL.0b013e3181cff776
6. Zanchetti A, Liu L, Mancia G et al. Blood pressure and low‑density lipoprotein‑cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence. J Hypertens. 2014;32:1741-1750.
7. Cífková R, Bruthans J, Adámková V et al. Prevalence základních kardiovaskulárních rizikových faktorů v české populaci v letech 2006–2009. Studie Czech post‑MONICA. Cor Vasa. 2011;53:220-222.
8. Hong SK. Blood Pressure Management for Stroke Prevention and in Acute Stroke. J Stroke. 2017;19(2): 152-165. doi: 10.5853/jos.2017.00164
9. Kohok DD, Sico JJ, Bae F et al. Post-stroke hypertension control and receipt of health care services among veterans. JCH. 2018;20(2):382-387. https://doi.org/10.1111/jch.13194
10. Ahmed N, Audebert H, Turc G et al. Consensus statements and recommendations from the ESO‑Karolinska Stroke Update Conference, Stockholm 11-13 November 2018. European Stroke Journal. 2019;4(4):307-317 https://doi.org/10.1177/2396987319863606
11. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart Journal. 2018;39(33): 3021-3104 https://doi.org/10.1093/eurheartj/ehy339
12. Williamson JD, Supiano MA, Applegate WB et al., SPRINT Research Group. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA. 2016;315:2673-2682.
13. Ettehad D, Emdin CA, Kiran A et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta‑analysis. Lancet. 2016;387: 957-967.
14. Emdin CA, Rahimi K, Neal B et al. Blood pressure lowering in type 2 diabetes: a systematic review and meta‑analysis. JAMA. 2015;313:603-615.
15. PROGRESS Collaborative Group Randomised trial of a perindopril‑based blood‑pressure‑lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358(9287):1033-1041.
16. Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ. 1994;308: 367-372.
17. Amarenco P. Lipid lowering and reccurent stroke: another stroke paradox. Eur Heart J. 2005;26:1818-1819.
18. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-1389.
19. Cholesterol Treatment Trialists’ Collaborators. Efficacy and safety of cholesterol‑lowering treatment: retrospective meta‑analysis of data from 90056 participants of 14 randomised trials of statins. Lancet 2005;366:1267-1278.
20. Amarenco P, Bogousslavsky J, Callahan A et al. SPARCL Investigators. High‑dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549-555.
21. Amarenco P, Goldstein LB, Szarek M et al. SPARCL Investigators. Effects of intense LDL‑c reduction in patients with stroke or transient ischemic attack: the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke. 2007;38:3198-3204.
22. Amarenco P, Kim JS, Labreuche J et al. Treat Stroke to Target Investigators. A comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med. 2020 Jan 2; 382(1): 9.
23. Cannon CP, Blazing MA, Giugliano RP et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372:2387-2397.
24. Sabatine MS, Giugliano RP, Wiviott SD et al. Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. N Engl J Med. 2015;372:1500-1509.
25. Jukema JW, Zijlstra LE,Bhatt DL et al. Effect of alirocumab on stroke in ODYSSEY OUTCOMES. Circulation. 2019;140:2054-2062.
26. Koenig W, Ray KK, Kallend DG et al. Efficacy and safety of inclisiran in patients with established cerebrovascular disease: pooled, post hoc analysis of the ORION-9, ORION-10 and ORION-11, phase 3 randomised clinical trials. Data presented at the ESC Congress –The Digital Experience. August 2021;27-30.
27. Ray K, Wright R, Kallend D et al. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 2020;382(16):1507-1519.
28. Visseren FL, Mach F, Smulders YM et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European Heart Journal. 42(34):32273337, Avaible from: https://doi.org/10.1093/eurheartj/ehab484.
29. Mach F, Baigent C, Catapano AL et al. [ESC Scientific Document Group]. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2019; pii: ehz455. <http://dx.doi.org/10.1093/eurheartj/ehz455>.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2022 Issue 3
Most read in this issue
- Differential diagnosis of chronic lower limb edema
- Hypertension and dyslipidemia treament in stroke
- Dyslipidemia and PCSK9 inhibitors – practical focused update of indication and reimbursement criteria
- Use of telemedicine in patients with heart failure