From the Guidelines
For stroke patients, treatment with a thiazide diuretic, angiotensin-converting enzyme inhibitor, or angiotensin II receptor blockers is recommended to lower blood pressure and reduce recurrent stroke risk. The goal of treatment is to achieve an office blood pressure of <130/80 mm Hg for most patients, although a systolic blood pressure target of 120–129 mmHg is recommended for patients with a history of TIA or stroke and confirmed blood pressure ≥130/80 mmHg, as long as treatment is tolerated 1.
Key Medications
- Thiazide diuretics
- Angiotensin-converting enzyme inhibitors
- Angiotensin II receptor blockers
- Calcium channel blockers (CCBs) can also be used in combination with a RAS blocker for preventing stroke 1
Treatment Approach
Treatment usually begins with a single medication at a low dose, which may be increased or combined with other medications if needed. It's essential to take these medications consistently, even when feeling well, as hypertension is often symptomless but remains a major stroke risk factor. Regular blood pressure monitoring and follow-up appointments with healthcare providers are crucial to ensure the medication regimen is effective and well-tolerated.
Individualized Care
Individualized drug regimens that take into account patient comorbidities, agent pharmacological class, and patient preference are recommended to maximize drug efficacy 1. This approach allows for tailored treatment plans that address the unique needs of each patient, ultimately reducing the risk of recurrent stroke and improving overall quality of life.
From the FDA Drug Label
Losartan Potassium Tablets is used: • Alone or with other blood pressure medicines to lower high blood pressure (hypertension). • To lower the chance of stroke in patients with high blood pressure and a heart problem called left ventricular hypertrophy Drugs that lower blood pressure lower your risk of having a stroke or heart attack The medications losartan, lisinopril, and amlodipine can be used to lower blood pressure and reduce the risk of stroke.
- Losartan is used to lower the chance of stroke in patients with high blood pressure and left ventricular hypertrophy.
- Lisinopril is used to treat hypertension, which can reduce the risk of stroke.
- Amlodipine is a calcium channel blocker that can help lower blood pressure and reduce the risk of stroke or heart attack. 2 3 4
From the Research
Stroke and Blood Pressure Medications
The relationship between stroke and blood pressure medications is a complex one, with various studies examining the effects of different antihypertensive drugs on stroke outcomes.
- The use of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and calcium channel blockers (CCBs) has been shown to be effective in stroke prevention 5.
- Combination antihypertensive therapy with a renin-angiotensin-aldosterone system (RAAS) blocker and a CCB may help reduce stroke incidence to a greater extent than either of the monotherapies 5.
- A study examining the effects of a calcium channel blocker or ACE inhibitor/ARB-based regimen on blood pressure variability (BPV) in patients with ischemic stroke or transient ischemic attack (TIA) found that BPV is increased after stroke and is associated with poor outcomes 6.
Antihypertensive Therapy
Antihypertensive therapy is crucial in the management of hypertension, with various classes of drugs available, including ACEIs, ARBs, CCBs, and thiazide diuretics.
- The European hypertension guidelines recommend combining ACEIs or ARBs with CCBs and/or thiazide diuretics to improve blood pressure control 7.
- Triple fixed-dose combination therapy with an ARB, CCB, and thiazide diuretic has been shown to be effective in reducing blood pressure and improving patient adherence to therapy 7.
- ACEIs, angiotensin II receptor antagonists, and calcium antagonists are effective and well-tolerated antihypertensive agents, but should be considered alternative drugs for first-line therapy until randomized trials show that they are at least as effective as diuretics and beta-blockers in preventing cardiovascular morbidity and mortality 8.
Guideline-Concordant ACE Inhibitor/ARB Utilization
The use of ACE inhibitors or ARBs among hypertensive US adults with albuminuria has been examined in several studies.
- US hypertension guidelines have recommended ACE inhibitors or ARBs as first-line antihypertensive therapy in the presence of albuminuria since 2003 9.
- However, a study found that there were no consistent trends in guideline-concordant ACE inhibitor/ARB utilization among adults with albuminuria from 2001 to 2018 9.
- ACE inhibitor/ARB underutilization represents a significant gap in preventive care delivery for adults with hypertension and albuminuria, with nearly half of those not receiving ACE inhibitor/ARB therapy not having diabetes 9.