Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence

Zanchetti A, Liu L, Mancia G, Parati G, Grassi G, Stramba-Badiale M, Silani V, Bilo G, Corrao G, Zambon A, Scotti L, Zhang X, Wang H, Zhang Y, Zhang X, Guan TR, Berge E, Redon J, Narkiewicz K, Dominiczak A, Nilsson P, Viigimaa M, Laurent S, Agabiti-Rosei E, Wu Z, Zhu D, Luis Rodicio J, Miguel Ruilope L, Martell-Claros N, Pinto F, Schmieder R, Burnier M, Banach M, Cifkova R, Farsang C, Konradi A, Lazareva I, Sirenko Y, Dorobantu M, Postadzhiyan A, Accetto R, Jelakovic B, Lovic D, Manolis AJ, Stylianou P, Erdine S, Dicker D, Wei G, Xu C, Xie H, Coca A, O'Brien J, Ford G (2014)

Publication Type: Journal article

Publication year: 2014

Journal

Book Volume: 32

Pages Range: 1741-50

Journal Issue: 9

DOI: 10.1097/HJH.0000000000000253

Abstract

It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke.A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak.A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.

Authors with CRIS profile

Involved external institutions

Medical University Gdansk / Gdański Uniwersytet Medyczny Poland (PL) University of Glasgow United Kingdom (GB) Lund University / Lunds universitet Sweden (SE) Tallinn University of Technology Estonia (EE) Georges Pompidou European Hospital / Hôpital Européen Georges-Pompidou (HEGP) France (FR) Università degli Studi di Brescia Italy (IT) Beijing Anzhen Hospital China (CN) Chinese Hypertension League China (CN) Universidad Complutense de Madrid (UCM) Spain (ES) Hospital Universitario 12 de Octubre Spain (ES) Hospital Clínico San Carlos Spain (ES) Centro Hospitalar de Entre o Douro e Vouga, E.P.E. Portugal (PT) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Medical University of Łódź / Uniwersytet Medyczny w Łodzi Poland (PL) St. Imre Teaching Hospital Hungary (HU) Federal Almazov North-West Medical Research Centre Russian Federation (RU) Respublican Scientific and Practical Center “Cardiology” Belarus (BY) M.D. Strazhesko Institute of Cardiology Ukraine (UA) Bucharest Emergency University Hospital Romania (RO) University Hospital St. Anna Bulgaria (BG) Ljubljana University Medical Centre (Ljubljana UMC) / Univerzitetni klinični center Ljubljana Slovenia (SI) Zagreb University Hospital Centre / Klinički bolnički centar Zagreb (KBC) Croatia (HR) Asclepeion Hospital Greece (GR) Nicosia General Hospital Cyprus (CY) Istanbul University / İstanbul Üniversitesi Turkey (TR) Rabin Medical Center / מרכז רפואי רבין‎‎ Israel (IL) Beijing Xuanwu Hospital China (CN) Peking University (PKU) / 北京大学 China (CN) Universitat de Barcelona (UB) / University of Barcelona Spain (ES) University of Cambridge United Kingdom (GB) Oxford University Hospitals NHS Foundation Trust United Kingdom (GB) Univerzita Karlova v Praze / Charles University in Prague Czech Republic (CZ) Istituto Scientifico Ospedale San Luca (Istituto Auxologico Italiano) Italy (IT) University of València / Universitat de València Spain (ES) University of Milano-Bicocca / Università degli Studi di Milano-Bicocca, UNIMIB Italy (IT) Oslo University Hospital / Oslo Universitetssykehus Rikshospitalet Norway (NO) Fuwai Cardiovascular Hospital China (CN)

How to cite

APA:

Zanchetti, A., Liu, L., Mancia, G., Parati, G., Grassi, G., Stramba-Badiale, M.,... Ford, G. (2014). Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence. Journal of Hypertension, 32(9), 1741-50. https://doi.org/10.1097/HJH.0000000000000253

MLA:

Zanchetti, Alberto, et al. "Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence." Journal of Hypertension 32.9 (2014): 1741-50.

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