Clinical question
How effective are blood pressure-lowering drugs (BPLDs) started at least 48 hours after the index event, for the prevention of recurrent stroke, major vascular events and dementia in people with stroke or transient ischaemic attack (TIA)?
Bottom line
BPLDs lowered the risk of recurrent stroke in patients with a stroke or TIA, but there was insufficient evidence to conclude whether they reduced the risk of other blood vessel diseases and dementia. BPLDs appeared to be most effective in people with high baseline blood pressure (BP > 140mmHg). There was insufficient evidence to conclude which BP target was best. Evidence was primarily derived from trials studying an ACE inhibitor or a diuretic.
Caveat
Not all trials contributed information to all outcomes.
Context
Stroke is an important cause of death and disability worldwide. Since high BP is an important risk factor for stroke and stroke recurrence, drugs that lower BP might play an important role in secondary stroke prevention.
Cochrane Systematic Review
Zonneveld TP et al. Blood pressure-lowering drugs for preventing recurrent stroke, major vascular events and dementia in patients with a history of stroke or transient ischaemic attack. Cochrane Reviews, 2018, Issue 8. Art. No.: CD007858.DOI: 10.1002/14651858. CD007858.pub2. This review contains 11 studies involving 38,742 participants.
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