A large body of epidemiological evidence demonstrates that the rate of cerebrovascular events is directly related to clinic blood pressure values. Although highly statistically significant, however, the relationship is not very close, which implies that within a general trend several patients with a lower blood pressure suffer from a stroke whereas other patients with a higher blood pressure do not. Whether and to what extent the ability to predict the future occurrence of stroke can be increased is discussed in this paper, which considers three main possibilities: (1) genetic factors that make some populations and individuals more prone to the occurrence of a cerebrovascular event for a given systolic or diastolic blood pressure, (2) risk factors other than hypertension (e.g. smoking) interacting in a positive fashion to increase the stroke risk profile, and (3) evaluation of blood pressure by ambulatory monitoring rather than by 'clinic' measurements. This last possibility is supported by studies that show that the end organ damage associated with hypertension is more closely related to 24-hour average than to clinic blood pressure and that the relationship becomes closer if 24-hour blood pressure variability is also taken into account. It is more specifically supported by evidence that 24-hour blood pressure values correlate more than clinic blood pressure with cerebrovascular damage, provided that the damage is quantified on an almost continuous scale by nuclear magnetic resonance rather than being expressed as an all-or-none clinical event. Improving prediction of future occurrence of stroke also improves efficacy of therapeutic intervention, thus having a great practical relevance. To date it would appear that the greatest protection against cerebrovascular events is obtained by removal of risk factors other than hypertension and by effective control of 24-hour blood pressure. Although the matter is still controversial, this should include a reduction in nighttime blood pressure at least in patients with no major organ damage.
|Number of pages||3|
|Publication status||Published - 1994|
- blood pressure
ASJC Scopus subject areas
- Internal Medicine