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Arterial hypertension and ischaemic stroke

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Droste DW, Ritter MA, Dittrich R, Heidenreich S, Wichter T, Freund M, Ringelstein EB. Arterial hypertension and ischaemic stroke.

Acta Neurol Scand 2003: 107: 241–251. © Blackwell Munksgaard 2003. Objectives –

Arterial hypertension is, besides age, the number one risk factor for ischaemic stroke. Patients with arterial hypertension frequently present with additional coexisting vascular risk factors interacting in a complex way. Material and methods –

This paper reviews the benefit of antihypertensive treatment, as well as different treatment options of arterial hypertension and their side-effects. Results –

Patients with definite arterial hypertension, but also patients with so-called normal or high-normal blood pressure are at increased risk to develop stroke and other cardiovascular complications. Vascular remodelling of small and large vessels provoked by arterial hypertension is the initial step in the development of atherosclerosis and lipohyalinosis. Vascular remodelling can be improved or even normalized by antihypertensive treatment with angiotensin-converting-enzyme inhibitors and angiotensin-I-receptor antagonists showing the most convincing effects. Angiotensin-converting-enzyme inhibitors and angiotensin-I-receptor antagonists have the lowest rate of side-effects, however, economic restraints hinder their general application. Statins are needed to treat dyslipidaemia. They also lower blood pressure and have a synergistic effect with the above two antihypertensive components in lowering blood pressure. In hypertensive patients, risk of stroke and other cardiovascular complications is determined by the blood pressure level and the presence or absence of target organ damage and the interaction with other risk factors, such as cigarette smoking, dyslipidaemia, and diabetes. These high-risk patients should be treated even more aggressively than usual. Conclusions –

In the vast majority of patients and healthy individuals, target blood pressure should be as high as or below 120/80 mmHg to minimize the occurrence of stroke and other cardiovascular complications.
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Keywords: hypertension; stroke; treatment

Document Type: Review Article

Affiliations: 1: Department of Neurology, University of Münster, Germany; 2: Department of Medicine D, University of Münster, Germany; 3: Department of Cardiology and Angiology, University of Münster, Germany; 4: Department of Clinical Radiology, University of Münster, Germany

Publication date: 2003-04-01

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