Heterogeneity was present for several outcomes and was partly related to the class of antihypertensive drugs used ; angiotensin-converting enzyme inhibitors and diuretics separately , and especially together , reduced vascular events , while beta-receptor antagonists had no discernable effect .
Evidence from r and omized controlled trials supports the use of antihypertensive agents in lowering blood pressure for the prevention of vascular events in patients with previous stroke or transient ischemic attack .
Vascular prevention is associated positively with the magnitude by which blood pressure is reduced
BACKGROUND High blood pressure is a risk factor for stroke recurrence .
We assessed the effectiveness of lowering blood pressure in preventing recurrent vascular events in patients with previous stroke or transient ischemic attack .
Comparative Effects of Ramipril on Ambulatory and Office Blood Pressures: A HOPE Substudy
In the HOPE-trial , the ACE inhibitor ramipril significantly reduced cardiovascular morbidity and mortality in patients at high risk for cardiovascular events . The benefit could only partly be attributed to the modest mean reduction of office blood pressure ( OBP ) during the study period ( 3/2 mm Hg ) . However , because according to the HOPE protocol ramipril was given once daily at bedtime and blood pressure was measured during the day , the 24-hour reduction of blood pressure may be underestimated based on OBP . Thirty-eight patients with peripheral arterial disease enrolled in the HOPE study underwent  24-hour ambulatory blood pressure ( ABP ) measurement  before r and omization and after 1 year . OBP was measured in the sitting position immediately before fitting the ABP measuring equipment to the patients . Ramipril did not significantly reduce OBP ( 8/2 mm Hg , P = NS ) or day ABP ( 6/2 mm Hg , P = NS ) after 1 year . Twenty-four – hour ABP was significantly reduced ( 10/4 mm Hg , P = 0.03 ) , mainly because of a more pronounced blood pressure lowering effect during nighttime ( 17/8 mm Hg , P < 0.001 ) . The night/day ratio was also significantly lowered in the ramipril  group . ABP shows greater falls , especially at night , than OBP during treatment with ramipril given once daily at bedtime . Although , OBP is the correct comparator when comparing with previous large intervention trials and epidemiological studies , the effects on cardiovascular morbidity and mortality seen with ramipril in the HOPE study may , to a larger extent than previously ascribed , relate to effects on blood pressure patterns over the 24-hour period
Heterogeneity was present for several outcomes and was partly related to the class of antihypertensive drugs used ; angiotensin-converting enzyme inhibitors and diuretics separately , and especially together , reduced vascular events , while beta-receptor antagonists had no discernable effect .
Evidence from r and omized controlled trials supports the use of antihypertensive agents in lowering blood pressure for the prevention of vascular events in patients with previous stroke or transient ischemic attack .
Vascular prevention is associated positively with the magnitude by which blood pressure is reduced
BACKGROUND High blood pressure is a risk factor for stroke recurrence .
We assessed the effectiveness of lowering blood pressure in preventing recurrent vascular events in patients with previous stroke or transient ischemic attack .