Treating hypertension doesn’t reduce stroke risk??? Another one down the drain

This is one of the most popular journal items for Medscape in the first half of the year–no doubt.

I kills what was thought at one time to be well established–treat the numbers with hypertension. Not so, and another question is posed.

I would warn you that the devil is in the details–that people requiring multiple medications to control their BP probably have some intrinsic problems that increases stroke risk even when their numbers are controlled with treatment.

Blood Pressure Control Does Not Prevent Increased Stroke Risk
Stroke; A Journal of Cerebral Circulation

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The investigators of this study of 26,875 individuals, aged ≥45 years and either black or white, assessed incident stroke events and their association with systolic blood pressure. Patients were categorized by systolic blood pressure (SBP) and number of antihypertensive medications. There were 4 classes of blood pressure: normal (<120 mm Hg), prehypertension (SBP, 120–139 mm Hg), stage 1 hypertension (140–159 mm Hg), and stage 2 hypertension (≥160 mm Hg); and 4 classes for medication use: 0, 1, 2, and ≥3. In the 6.3 years of follow-up, 823 stroke events occurred, and 46% were in individuals with successfully treated hypertension (SBP, <140 mm Hg). Within the blood pressure classes, the risk for stroke increased with each addition to the antihypertensive medications regimen required. A successfully treated hypertensive individual (SBP <120 mm Hg) using ≥3 medication classes had a marginally higher stroke risk than an individual with untreated stage 1 hypertension.

Even with successful pharmacological treatment of hypertension, there is increased risk for stroke, as nearly half of the population treated to guideline (SBP <140 mm Hg) failed to return to risk levels similar to those in normotensive individuals.

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