CONCLUSION Despite recent large trials showing no significant effect , in patients that have experienced a TIA or stroke , blood pressure lowering agents reduced the occurrence of subsequent stroke and cardiovascular events .
The rate of myocardial infa rct ion and all-cause mortality was unchanged
BACKGROUND While hypertension is a leading risk factor for an initial stroke , the role of blood pressure lowering to prevent subsequent stroke is less clear .
The results of recent large clinical trials investigating effects of antihypertensive agents in patients with a history of stroke have not shown a significant benefit ; findings that are at odds with previous data .
Our meta- analysis systematic ally evaluates the available , relevant trials to examine the role of antihypertensive drugs in preventing recurrent stroke .
The Influence of Nicardipine in Patients with High Risk of Stroke
Blood pressure and clinical status of 1,736 patients with cerebrovascular disease were observed during 12 months of treatment with nicardipine . The most common diagnoses were chronic cerebral ischemia ( 53.2 % ) , transient ischemic attacks ( TIA ; 25.1 % ) , and cerebral infa rct ( 8.7 % ) ; 50.1 % of patients were classed as hypertensive [ systolic blood pressure ( SBP ) ≥ 160 mm Hg or diastolic blood pressure ( DBP ) ≥ 90 mm Hg ] . Most patients ( 91.2 % ) received a daily dose of 60 mg nicardipine . Additional treatments included diuretics ( 37 % ) , β-blockers ( 11.5 % ) , other antihypertensive drugs ( 15.8 % ) , platelet antiaggregants ( 25.1 % ) , and cardiotonic drugs ( 15.1 % ) . A total of 282 patients ( 16.2 % ) were lost to follow-up , 21 ( 1.2 % ) patients withdrew due to side effects , 32 ( 1.8 % ) died , and 9 ( 0.5 % ) patients had treatment interrupted due to concomitant illness . In the hypertensive subgroup , blood pressure ( SBP/ DBP ) was reduced from a mean baseline value of 175 ± 22/97 ± 14 mm Hg to 152 ± 17/85 ± 11 mm Hg at 3 months and 149 ± 23/81 ± 11 mm Hg after 12 months of treatment . The incidence of TIA or stroke among these patients was reduced from 29 cases ( 3.5 % ) during the first 3 months to 11 cases ( 1.54 % ) during months 4–12 ( p < 0.01 ) . In normotensive patients there were 18 ( 2.15 % ) cases during months 1–3 and 13 ( 1.55 % ) cases during months 4–12 ( difference not significant ) . In the 280 patients treated  with nicardipine alone , the most frequent side effects during the first month were facial flushing ( 6.8 % ) , gastrointestinal problems ( 5 % ) , dizziness ( 3.2 % ) , headache ( 3.2 % ) , drowsiness ( 3.2 % ) , and hypotension ( 1.1 % ) . Most of these side effects were transient . These results demonstrate that nicardipine lowered blood pressure over the 12 months of observation . This may have contributed to the reduction in the incidence of TIA or stroke among hypertensive patients during months 4–12
CONCLUSION Despite recent large trials showing no significant effect , in patients that have experienced a TIA or stroke , blood pressure lowering agents reduced the occurrence of subsequent stroke and cardiovascular events .
The rate of myocardial infa rct ion and all-cause mortality was unchanged
BACKGROUND While hypertension is a leading risk factor for an initial stroke , the role of blood pressure lowering to prevent subsequent stroke is less clear .
The results of recent large clinical trials investigating effects of antihypertensive agents in patients with a history of stroke have not shown a significant benefit ; findings that are at odds with previous data .
Our meta- analysis systematic ally evaluates the available , relevant trials to examine the role of antihypertensive drugs in preventing recurrent stroke .