From the Guidelines
The 2024 preventive stroke guidelines from the American Heart Association/American Stroke Association recommend a comprehensive approach to primary prevention, focusing on modifiable risk factors, including the use of antiplatelet therapy, blood pressure-lowering medications, and cholesterol-lowering therapy, as well as lifestyle modifications.
Key Recommendations
- For primary prevention, the guidelines suggest using risk prediction instruments, such as the Pooled Cohort Equation or the newly developed Predicting Risk of CVD Events equations, to estimate stroke risk and guide decision-making on initiation of preventive therapies 1.
- The CHA2DS-VASc score is recommended to inform risk-based anticoagulation of patients with nonvalvular atrial fibrillation, with oral anticoagulation suggested for patients with an annual stroke risk ≥2% 1.
- Lifestyle modifications, including a healthy diet, regular physical activity, smoking cessation, and maintaining a healthy weight, are crucial for reducing stroke risk.
Medication Therapy
- Blood pressure-lowering medications, such as ACE inhibitors, ARBs, or calcium channel blockers, are recommended to maintain blood pressure below 130/80 mmHg.
- Statins, particularly high-intensity statins, are recommended for those with elevated cholesterol.
- For patients with atrial fibrillation, anticoagulation with direct oral anticoagulants (DOACs) is preferred over warfarin when appropriate.
Secondary Prevention
- Dual antiplatelet therapy with aspirin and clopidogrel is recommended for 21-90 days after a transient ischemic attack (TIA) or stroke, followed by single antiplatelet therapy long-term. These interventions aim to reduce atherosclerosis, control hypertension, prevent thrombus formation, and improve overall vascular health, ultimately reducing the risk of stroke and improving patient outcomes 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Current Preventive Stroke Guidelines
There are no current preventive stroke guidelines from 2024 available in the provided studies. However, the available studies provide information on the management of blood pressure for stroke prevention.
Blood Pressure Management
- The studies suggest that hypertension is a major risk factor for stroke and that reducing blood pressure can lower the risk of stroke 2, 3, 4, 5, 6.
- The recommended blood pressure target varies among the studies, but most suggest a target of <140/90 mmHg for the general population and <130/80 mmHg for individuals with high cardiovascular risk or diabetes 2, 3, 4.
- The use of antihypertensive medications such as angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), dihydropyridine calcium channel blockers (CCB), and thiazide diuretics is recommended for blood pressure management 2, 3, 5, 6.
- Lifestyle modifications and pharmacotherapy are also recommended for patients with hypertension to reduce the risk of stroke 3, 6.
Antihypertensive Medications
- The studies compare the efficacy of different antihypertensive medications, including ACEI, ARB, CCB, and diuretics, and suggest that they have similar effects on reducing blood pressure and stroke risk 2, 3, 5, 6.
- However, one study suggests that ARBs may have fewer adverse events compared to ACEI, and may be a better choice for some patients 5.