This protocol applies to patients with hypertension who also have a prior history of ischemic stroke, transient ischemic attack (TIA), or intracerebral hemorrhage (ICH). In this population, persistently elevated blood pressure poses a heightened risk of recurrent cerebrovascular events.
The combination of hypertension with a prior cerebrovascular event — ischemic stroke, TIA, or ICH — defines a high-risk subgroup. BP reduction in these patients targets both primary hypertension control and secondary prevention of recurrent stroke and ICH.
Management involves specific antihypertensive medication classes — including certain diuretic agents — selected to lower blood pressure and reduce the risk of recurrent cerebrovascular events. Additional medication options are available when further BP control is required.
The full protocol specifies agent selection, escalation criteria, and sequencing to achieve the recommended target:
Target: Office SBP/DBP <130/80 mm HgIn patients with hypertension who have experienced an ischemic stroke, transient ischemic attack (TIA), or ICH, treatment with a thiazide-type diuretic, ACEi, or ARB is recommended for lowering BP and reducing recurrent stroke and ICH risk.
However, the use of CCBs is acceptable for patients with stroke who require additional medication options.
In patients with hypertension who have experienced an ischemic stroke, TIA, or ICH, an office SBP/DBP goal of <130/80 mm Hg is recommended to reduce the risk of recurrent stroke, ICH, and other vascular events.
DOI: 10.1161/CIR.0000000000001356
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