1. Stroke prevention in patients with arterial hypertension: Recommendations of the Spanish Society of Neurology's Stroke Study Group
- Author
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Rodriguez-Yanez, M., Gomez-Choco, M., Lopez-Cancio, E., Amaro, S., Alonso de Lecinana, M., Arenillas, J. F., Ayo-Martin, O., Castellanos, M., Freijo, M. M., Garcia-Pastor, A., Gomis, M., Martinez Sanchez, P., Morales, A., Palacio-Portilla, E. J., Roquer, J., Segura, T., Serena, J., Vivancos-Mora, J., Fuentes, B., Soc Espanola Neurologia, [Rodriguez-Yanez, M.] Hosp Univ Santiago de Compostela, Serv Neurol, La Coruna, Spain, [Gomez-Choco, M.] Hosp St Joan Despi Moises Broggi, Serv Neurol, Barcelona, Spain, [Lopez-Cancio, E.] Hosp Univ Cent Asturias, Serv Neurol, Oviedo, Spain, [Amaro, S.] Hosp Clin & Univ, Serv Neurol, Barcelona, Spain, [Amaro, S.] Univ Barcelona, Dept Med, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Spain, [Alonso de Lecinana, M.] Hosp Univ La Paz, Serv Neurol, Madrid, Spain, [Fuentes, B.] Hosp Univ La Paz, Serv Neurol, Madrid, Spain, [Alonso de Lecinana, M.] Univ Autonoma Madrid, Dept Med, Area Neurociencias, Inst Invest IdiPAZ, Madrid, Spain, [Fuentes, B.] Univ Autonoma Madrid, Dept Med, Area Neurociencias, Inst Invest IdiPAZ, Madrid, Spain, [Arenillas, J. F.] Hosp Clin Univ Valladolid, Serv Neurol, Valladolid, Spain, [Ayo-Martin, O.] Complejo Hosp Univ Albacete, Serv Neurol, Albacete, Spain, [Segura, T.] Complejo Hosp Univ Albacete, Serv Neurol, Albacete, Spain, [Castellanos, M.] Complejo Hosp Univ A Coruna, Serv Neurol, La Coruna, Spain, [Castellanos, M.] Inst Invest Biomed A Coruna, La Coruna, Spain, [Freijo, M. M.] Hosp Univ Cruces, Serv Neurol, Biocruces Bizkaia Hlth Res Inst, Baracaldo, Vizcaya, Spain, [Garcia-Pastor, A.] Hosp Univ Gregorio Maranon, Serv Neurol, Madrid, Spain, [Garcia-Pastor, A.] Univ Complutense Madrid, Madrid, Spain, [Gomis, M.] Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Serv Neurol, Barcelona, Spain, [Martinez Sanchez, P.] Hosp Torrecardenas, Serv Neurol, Almeria, Spain, [Morales, A.] Hosp Clin Univ Virgen Arrixaca, Serv Neurol, Murcia, Spain, [Morales, A.] Inst Murciano Invest Biomed IMIB, Murcia, Spain, [Palacio-Portilla, E. J.] Univ Cantabria, Hosp Univ Marques de Valdecilla, Serv Neurol, IDIVAL, Santander, Spain, [Roquer, J.] Hosp Mar, Serv Neurol, Barcelona, Spain, [Serena, J.] Hosp Univ Doctor Josep Trueta, Serv Neurol, Girona, Spain, [Serena, J.] Hosp Univ Doctor Josep Trueta, Biomed Res Inst Girona, Girona, Spain, [Vivancos-Mora, J.] Univ Autonoma Madrid, Serv Neurol, Hosp Univ La Princesa, Madrid, Spain, and [Vivancos-Mora, J.] Univ Autonoma Madrid, Inst Invest Sanitaria Princesa, Madrid, Spain
- Subjects
Blood pressure control ,medicine.medical_specialty ,Neurology ,Ischemic-stroke ,Blood-pressure reduction ,Blood Pressure ,Ictus ,Age ,Primary prevention ,medicine ,Humans ,In patient ,Mortality ,RC346-429 ,Antihypertensive drugs ,Stroke ,Antihypertensive Agents ,Presión arterial ,business.industry ,Prevention ,Metaanalysis ,medicine.disease ,Clinical trial ,Blood pressure ,Prevención ,Stroke prevention ,Emergency medicine ,Hypertension ,Neurology. Diseases of the nervous system ,business ,Randomized-trial ,Fármacos antihipertensivos - Abstract
Objective: To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. Development: We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. Conclusions: In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels > 140/90 mmHg, with a target BP of < 130/80 mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24 hours), with a target BP of < 130/80 mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable. Resumen: Objetivo: Actualizar las recomendaciones de la Sociedad Española de Neurología para la prevención de ictus, tanto primaria como secundaria, en pacientes con hipertensión arterial. Desarrollo: Se han planteado diferentes preguntas para identificar cuestiones prácticas para el manejo de la presión arterial (PA) en prevención de ictus, analizando cuál debe ser el objetivo de control de la presión arterial y cuáles son los fármacos más adecuados en prevención primaria, cuándo iniciar el tratamiento antihipertensivo después de un ictus, cuáles son las cifras que debemos alcanzar y qué fármacos son los más adecuados en prevención secundaria de ictus. Se ha realizado una revisión sistemática en Pubmed analizando los principales ensayos clínicos para dar respuesta a estas preguntas y se han elaborado unas recomendaciones. Conclusiones: En prevención primaria se recomienda iniciar tratamiento antihipertensivo con cifras de PA > 140/90 mmHg, con un objetivo de control de PA
- Published
- 2021