High blood pressure (BP) is the most important modifiable risk factor for stroke and other vascular diseases. Evidence from randomized controlled trials supports the use of antihypertensive drugs to lower blood pressure for stroke prevention. There is some evidence that specific classes of antihypertensive drugs have different effects and/or their pharmacological actions differ in patient subgroups. This review evaluates the development of antihypertensive therapies and the latest studies of arterial hypertension and stroke prevention: HOPE trial (ramipril versus placebo), ALLHAT trial (CCB or/ and Angiotensin-Conventing enzyme Inhibitors (ACE-Is) versus diuretic), LIFE trial (losartan versus atenolol), and PROGRESS trial (perindopril or/and indapamide versus placebo). Despite the results of these relevant clinical trails, some aspects still remain unresolved. Future clinical trials on hypertension and stroke prevention should answer the following questions: Does lowering BP reduce stroke risk due to specific drug effect or class effect? Are angiotensin II receptor blockers (ARBs) better than ACE-Is? Should ACE-Is and ARBs be considered routinely for either high-risk stroke patients or patients with history of stroke or transient ischemic attack, irrespective of blood pressure? What is the role of lifestyle in BP control?

译文

:高血压(BP)是中风和其他血管疾病的最重要的可改变危险因素。随机对照试验的证据支持使用降压药降低血压以预防中风。有证据表明,特定类别的降压药在患者亚组中具有不同的作用和/或它们的药理作用。这篇综述评估了抗高血压疗法的发展以及动脉高血压和中风预防的最新研究:HOPE试验(雷米普利与安慰剂),ALLHAT试验(CCB或/和血管紧张素抑制酶抑制剂(ACE-Is)与利尿剂),LIFE试验(氯沙坦vs阿替洛尔)和PROGRESS试验(培哚普利或/和吲达帕胺vs安慰剂)。尽管取得了这些相关临床试验的结果,但仍未解决某些方面。未来有关高血压和中风预防的临床试验应回答以下问题:降低BP是否会由于特定的药物作用或类别作用而降低中风风险?血管紧张素II受体阻滞剂(ARB)是否比ACE-Is好?对于高危中风患者或有中风病史或短暂性脑缺血发作的患者,无论血压高低,均应常规考虑使用ACE-Is和ARB吗?生活方式在血压控制中的作用是什么?

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