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Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomized trial.
J Hypertens
September 2014
aIstituto Auxologico Italiano bUniversità di Milano, Milan, Italy cFuWai Hospital and Cardiovascular Institute dBeijing Hypertension League Institute, Beijing, China eUniversità Milano-Bicocca fIRCCS Multimedica, Sesto San Giovanni, Milan, Italy gOslo University Hospital, Oslo, Norway hUniversity of Valencia, Madrid, Spain iMedical University of Gdansk, Gdansk, Poland jUniversity of Glasgow, Glasgow, UK kLund University, Scania University Hospital, Malmö, Sweden lTallinn University of Technology, Tallinn, Estonia mEuropean Hospital Georges Pompidou, Paris, France nUniversità di Brescia, Spedali Civili, Brescia, Italy oBeijing Anzhen Hospital, Beijing pShanghai Hypertension Institute, China qComplutense University rHospital 12 de Octubre sHospital Clínico San Carlos, Madrid, Spain tCentro Hospitalar de Entre o Douro e Vouga, E.P.E., Portugal uNephrology and Hypertension, University Hospital, Erlangen, Germany vUniversity Hospital of Lausanne, Lausanne, Switzerland wMedical University of Lodz, Poland xCharles University Medical School I and Thomayer Hospital, Prague, Czech Republic ySt. Imre University Teaching Hospital, Budapest, Hungary zAlmazov Federal Heart, Blood and Endocrinology Center, St. Petersburg, Russia aaRSPC Cardiology, Minsk, Belarus abNSC 'Institute of Cardiology named after N.D. Strazhesko' of NAMS, Kiev, Ukraine acEmergency Hospital of Bucharest, Romania adUniversity Hospital Saint Anna, Sofia, Bulgaria aeDr Peter Drzai Hospital, Ljubljana, Slovenia afUniversity Hospital Center Zagreb, Croatia agClinic for Internal Medicine InterMedic, Nis, Serbia ahCardiology Department, Asklepeion General Hospital, Athens, Greece aiNicosia General Hospital, Nicosia, Cyprus ajIstanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey akHasharon Hospital - Rabin Medical Center, Petach-Tikva, Israel alBeijing Xuanwu Hospital amSecond Affiliate Hospital, Beijing University anMilitary General Hospital, China aoHospital Clinic. University of Barcelona, Ba
Background And Objectives: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design.
View Article and Find Full Text PDFBlood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence.
J Hypertens
September 2014
aIstituto Auxologico Italiano bUniversità di Milano, Milan, Italy cFuWai Hospital and Cardiovascular Institute dBeijing Hypertension League Institute, Beijing, China eUniversità Milano-Bicocca fIRCCS Multimedica, Sesto San Giovanni, Milan, Italy gOslo University Hospital, Oslo, Norway hUniversity of Valencia, Madrid, Spain iMedical University of Gdansk, Gdansk, Poland jUniversity of Glasgow, Glasgow, UK kLund University, Scania University Hospital, Malmo, Sweden lTallinn University of Technology, Tallinn, Estonia mEuropean Hospital Georges Pompidou, Paris, France nUniversità di Brescia, Spedali Civili, Brescia, Italy oBeijing Anzhen Hospital, Beijing pShanghai Hypertension Institute, Shanghai, China qComplutense University rHospital 12 de Octubre sHospital Clínico San Carlos, Madrid, Spain tCentro Hospitalar de Entre o Douro e Vouga, E.P.E., Portugal uNephrology and Hypertension, University Hospital, Erlangen, Germany vUniversity Hospital of Lausanne, Lausanne, Switzerland wMedical University of Lodz, Lodz, Poland xCharles University Medical School I and Thomayer Hospital, Prague, Czech Republic ySt. Imre University Teaching Hospital, Budapest, Hungary zAlmazov Federal Heart, Blood and Endocrinology Center, St. Petersburg, Russia aaRSPC Cardiology, Minsk, Belarus abNSC 'Institute of Cardiology named after N.D. Strazhesko' of NAMS, Kiev, Ukraine acEmergency Hospital of Bucharest, Bucharest, Romania adUniversity Hospital Saint Anna, Sofia, Bulgaria aeDr Peter Drzai Hospital, Ljubljana, Slovenia afUniversity Hospital Center Zagreb, Zagreb, Croatia agClinic for Internal Medicine InterMedic, Nis, Serbia ahCardiology Department, Asklepeion General Hospital, Athens, Greece aiNicosia General Hospital, Nicosia, Cyprus ajIstanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey akHasharon Hospital - Rabin Medical Center, Petach-Tikva, Israel alBeijing Xuanwu Hospital amSecond Affiliate Hospital, Beijing University anMilitary General Hospital, Beijing, China aoH
Background And Objectives: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke.
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