Hypertension and Stroke: 2005 Canadian Hypertension Educational Program Recommendations

BACKGROUND: Hypertension is the most important modifiable cause of stroke. The Canadian Hypertension Educational Program, representing Canada's experts in the field of hypertension, publishes annual evidence-based recommendations on the diagnosis and treatment of hypertension. METHODS: We present the 2005 Canadian Hypertension Educational Program guidelines regarding the management of hypertension in patients with stroke. RESULTS: The diagnosis of hypertension should be expedited and can be made as early as the second visit in patients with stroke. Unless contraindicated, a combination of angiotensin-converting-enzyme (ACE) inhibitors and diuretics is the preferred therapy in these patients. A target blood pressure below 140/90 mmHg for non-diabetic patients, below 130 mmHg/80 mmHg for diabetic patients and below 125 mmHg/75 mmHg for those with renal disease and proteinuria (> 1 gram per day) should be reached. Lifestyle interventions may be as effective as medication and should be used in conjunction with medical management. Waist circumference should be less than 102 cm for men and 88 cm for women. There remains uncertainty about the management of high blood pressure in the context of acute stroke. CONCLUSIONS: A combination of ACE-inhibitors and diuretics is recommended in hypertensive stroke patients. Blood pressure should be maintained below 140/90 mmHg.