Angiotensin Type 1 receptor blockers reduced stroke incidence by 24% (p=0.0002) compared to diuretics or beta-blockers, and blood pressure-lowering therapy reduced stroke recurrence by 25%.
Meta-Analysis
Does antihypertensive drug treatment reduce the incidence of stroke in patients with hypertension or a history of cerebrovascular disease?
Antihypertensive therapy, particularly with ARBs and CCBs, significantly reduces the risk of primary and secondary stroke, largely driven by differences in systolic blood pressure reduction.
Effect estimate: 24% reduction (ARBs)
p-value: p=0.0002
Hypertension is the most powerful risk factor for stroke. Antihypertensive drug treatment reduces the incidence of stroke. In a meta-analysis of actively controlled trials, calcium-channel blockers, including (-8%; p = 0.07) or excluding verapamil (-10%; p = 0.02), as well as angiotensin Type 1 receptor blockers (-24%; p = 0.0002) resulted in better stroke prevention than the old drugs (diuretics or beta-blockers), whereas the opposite trend was observed for angiotensin-converting enzyme inhibitors (+10%; p = 0.03). An overview of six trials conducted in patients with a history of cerebrovascular disease demonstrated that blood pressure-lowering therapy reduced stroke recurrence by 25% (p = 0.004). A meta-regression analysis showed that within-trial differences in systolic blood pressure accounted for the prevention of stroke in most trials. This finding was corroborated by the recently published Valsartan Antihypertensive Long-term Use Evaluation trial.
Wang et al. (Mon,) conducted a meta-analysis in Hypertension and history of cerebrovascular disease. Antihypertensive drug treatment (calcium-channel blockers, angiotensin Type 1 receptor blockers, ACE inhibitors) vs. Older drugs (diuretics or beta-blockers) was evaluated on Incidence of stroke (24% reduction (ARBs), p=0.0002). Angiotensin Type 1 receptor blockers reduced stroke incidence by 24% (p=0.0002) compared to diuretics or beta-blockers, and blood pressure-lowering therapy reduced stroke recurrence by 25%.