Linking Evidence-based Management in Hypertension to Real-world Experience for Preventing Stroke: An Indian Perspective
Article Sidebar
Main Article Content
Abstract
Currently, hypertension is the most critical modifiable risk factor for stroke. The current consensus article describes the clinical views of experts regarding various aspects of the link between hypertension and, stroke, risk assessment of stroke, blood pressure management and consequent stroke prevention, optimal blood pressure targets, along with current antihypertensive approaches. A literature search was performed using databases like PubMed and Google Scholar. Relevant articles were identified using keywords like ‘hypertension’, ‘blood pressure’, ‘stroke’, and, ‘antihypertensive therapy.’ After the screening, 44 relevant articles were identified and included in the current article. Appropriate blood pressure management with antihypertensive agents is the chief aspect of primary and secondary prevention of stroke. Clinical evidence has strongly established a significant reduction in the risk of first and recurrent stroke with BP-lowering therapy. As the risk of stroke continues to increase, there is a dire necessity to ensure evidence-based management of hypertension for preventing stroke in the Indian population. On similar grounds, the current consensus article aims at providing a collation of evidence-based literature and clinical insights of leading therapy experts of India in the field of neurology, cardiology, and medicine to optimise the management of hypertension and prevention of stroke.
Metrics
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
All open access articles published in the journal are distributed under the terms of the CC-BY-NC-SA 4.0 license (Creative Commons Attribution-Non-commercial-ShareAlike 4.0 International License) which permits unrestricted use, distribution, and reproduction in any medium, for non-commercial purposes, provided the original work is properly cited and distributed under the same license (ShareAlike). Under Creative Commons, authors retain copyright in their articles.
References
Vijna, Mishra CP. Prevalence and predictors of hypertension: Evidence from a study of rural India. J Family Med Prim Care. 2022;11(3):1047-1054.
Gaciong Z, Siński M, Lewandowski J. Blood pressure control and primary prevention of stroke: summary of the recent clinical trial data and meta-analyses. Curr Hypertens Rep. 2013;15(6):559-74.
Turana Y, Tengkawan J, Chia YC, et al. Hypertension and stroke in Asia: A comprehensive review from HOPE Asia. J Clin Hypertens (Greenwich). 2021;23(3):513-521.
Mohammed Nawi A, Mohammad Z, Jetly K, Abd Razak MA, Ramli NS, Wan Ibadullah WAH, et al. The Prevalence and Risk Factors of Hypertension among the Urban Population in Southeast Asian Countries: A Systematic Review and Meta-Analysis. Int J Hypertens. 2021;2021:6657003.
Zhang WL, Cai J. STEP to blood pressure management of elderly hypertension: evidence from Asia. Hypertens Res. 2022 Apr;45(4):576-582.
Sreeniwas Kumar A, Sinha N. Cardiovascular disease in India: A 360 degree overview. Med J Armed Forces India. 2020 Jan;76(1):1-3.
Gupta R, Xavier D. Hypertension: The most important non communicable disease risk factor in India. Indian Heart J. 2018 Jul-Aug;70(4):565-572.
Ramakrishnan S, Zachariah G, Gupta K, Shivkumar Rao J, Mohanan PP, Venugopal K, et al. Prevalence of hypertension among Indian adults: Results from the great India blood pressure survey. Indian Heart J. 2019;71(4):309-313.
Sethi R, Hiremath JS, Ganesh V, Banerjee S, Shah M, Mehta A, et al. Correlation between Stroke Risk and Systolic Blood Pressure in Patients over 50 Years with Uncontrolled Hypertension: Results from the SYSTUP-India Study. Cardiovasc Ther. 2021;2021:6622651.
Boehme AK, Esenwa C, Elkind MS. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017;120(3):472-495.
Dickinson CJ. Strokes and their relationship to hypertension. Curr Opin Nephrol Hypertens. 2003 Jan;12(1):91-6.
Yu JG, Zhou RR, Cai GJ. From hypertension to stroke: mechanisms and potential prevention strategies. CNS Neurosci Ther. 2011;17(5):577-84.
Pires PW, Dams Ramos CM, Matin N, Dorrance AM. The effects of hypertension on the cerebral circulation. Am J Physiol Heart Circ Physiol. 2013;304(12):H1598-614.
Di Napoli M, Papa F. Systemic inflammation, blood pressure, and stroke outcome. J Clin Hypertens (Greenwich). 2006 Mar;8(3):187-94.
Boehme AK, Esenwa C, Elkind MS. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017;120(3):472-495.
Shoamanesh A, Patrice Lindsay M, Castellucci LA, Cayley A, Crowther M, de Wit K, et al. Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020. Int J Stroke. 2021;16(3):321-341.
Gorelick PB, Whelton PK, Sorond F, Carey RM. Blood Pressure Management in Stroke. Hypertension. 2020 Dec;76(6):1688-1695.
Wajngarten M, Silva GS. Hypertension and Stroke: Update on Treatment. Eur Cardiol. 2019;14(2):111-115.
Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.
Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957-967.
Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. New England Journal of Medicine. 2008;358(18):1887-98.
Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP). Available at https://clinicaltrials.gov/ct2/show/NCT03015311 Accessed on 24’ Mar, 2023.
SPS3 Study Group, Benavente OR, Coffey CS, Conwit R, Hart RG, McClure LA, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382(9891):507-15.
Kitagawa K, Yamamoto Y, Arima H, Maeda T, Sunami N, Kanzawa T, et al. Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke: A Randomized Clinical Trial and Meta-analysis. JAMA Neurol. 2019;76(11):1309-1318.
Mant J, McManus RJ, Roalfe A, Fletcher K, Taylor CJ, Martin U, et al. Different systolic blood pressure targets for people with history of stroke or transient ischaemic attack: PAST-BP (Prevention After Stroke--Blood Pressure) randomised controlled trial. BMJ. 2016;352:i708.
Bath PM, Scutt P, Blackburn DJ, Ankolekar S, Krishnan K, Ballard C, et al. Intensive versus Guideline Blood Pressure and Lipid Lowering in Patients with Previous Stroke: Main Results from the Pilot 'Prevention of Decline in Cognition after Stroke Trial' (PODCAST) Randomised Controlled Trial. PLoS One. 2017;12(1):e0164608.
PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358:1033–41.
PATS Collaborating Group. Post-stroke antihypertensive treatment study. A preliminary result. Chin Med J (Engl). 1995;108(9):710-7.
Arima H, Chalmers J. PROGRESS: Prevention of Recurrent Stroke. J Clin Hypertens (Greenwich). 2011;13(9):693-702.
Hypertension Screening, Diagnosis, Assessment, and Management of Primary Hypertension in Adults in India. Available at https://nhm.gov.in/images/pdf/guidelines/nrhm-guidelines/stg/Hypertension_full.pdf Accessed on 14’ Nov, 2022.
Hansson L, Hedner T, Lund-Johansen P, Kjeldsen SE, Lindholm LH, Syvertsen JO, et al. Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet. 2000;356(9227):359-65.
Dahlof B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003.
Papademetriou V, Farsang C, Elmfeldt D, Hofman A, Lithell H, Olofsson B, et al. Stroke prevention with the angiotensin II type 1-receptor blocker candesartan in elderly patients with isolated systolic hypertension: the Study on Cognition and Prognosis in the Elderly (SCOPE). J Am Coll Cardiol. 2004;44(6):1175-80.
Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366(9489):895-906.
Einhorn PT, Davis BR, Massie BM, Cushman WC, Piller LB, Simpson LM, et al. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Heart Failure Validation Study: diagnosis and prognosis. Am Heart J. 2007;153(1):42-53.
Hong KS. Blood Pressure Management for Stroke Prevention and in Acute Stroke. J Stroke. 2017;19(2):152-165.
Yusuf S, Diener HC, Sacco RL, Cotton D, Ounpuu S, Lawton WA, et al. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med. 2008;359(12):1225-37.
Farsang C; Picasso Investigators. Blood pressure and metabolic efficacy of fixed-dose combination of perindopril and indapamide in everyday practice. Blood Press. 2013;22 Suppl 1:3-10.
Liang W, Ma H, Cao L, Yan W, Yang J. Comparison of thiazide-like diuretics versus thiazide-type diuretics: a meta-analysis. J Cell Mol Med. 2017;21(11):2634-2642.
Roush GC, Abdelfattah R, Song S, Ernst ME, Sica DA, Kostis JB. Hydrochlorothiazide vs chlorthalidone, indapamide, and potassium-sparing/hydrochlorothiazide diuretics for reducing left ventricular hypertrophy: A systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2018;20(10):1507-1515.
Zibaeenejad F, Mohammadi SS, Sayadi M, Safari F, Zibaeenezhad MJ. Ten-year atherosclerosis cardiovascular disease (ASCVD) risk score and its components among an Iranian population: a cohort-based cross-sectional study. BMC Cardiovasc Disord. 2022;22(1):162.
Menon VP, Edathadathil F, Sathyapalan D, Moni M, Don A, Balachandran S, et al. Assessment of 2013 AHA/ACC ASCVD risk scores with behavioral characteristics of an urban cohort in India: Preliminary analysis of Noncommunicable disease Initiatives and Research at AMrita (NIRAM) study. Medicine (Baltimore). 2016;95(49):e5542.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-e110.