More than 186 000 strokes occur every year in Italy, responsible for 10-12% of total mortality. Despite the reduction in mortality and disability, the incidence of stroke is persistently high and mortality within the first month is about 30%; furthermore, the severe residual disability is about 40% in survivors. Large clinical outcome trials have defined the strict correlation between stroke and systolic and diastolic hypertension, and several meta-analyses and intervention studies showed that reduction of blood pressure, independently of the drug used (diuretics, beta-blockers, calcium antagonists, angiotensin-converting enzyme inhibitors), decreases significantly (≥ 30%) stroke mortality and morbidity in hypertensives. Despite numerous and effective antihypertensive drugs, stroke mortality and morbidity in hypertensive subjects remain persistently higher than in normotensive ones. Two recent clinical studies confirmed the great efficacy of angiotensin II antagonists in reducing stroke relative risk in hypertensive patients at elevated cardiovascular risk. The LIFE study demonstrated that an active treatment is superior to another one in reducing the prefixed endpoint. This important result has conferred great expectancy on angiotensin II antagonists and on their possible "class effect". Considering the recent intervention trials and the correct interpretation of the evidence-based medicine, we should not consider all principles as belonging to the same category, equally effective in the prevention of cardiovascular risk. The concept of "class effect" has not a real scientific value and cannot replace the experimental results of clinical studies which represent the only bench test for the efficacy of a drug.
|Translated title of the contribution||What's new in the prevention of stroke?|
|Number of pages||7|
|Journal||Italian Heart Journal Supplement|
|Publication status||Published - 2003|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine