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

Abstract

BACKGROUND AND OBJECTIVES:

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.

RESULTS:

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.

CONCLUSION:

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: Alberto Zanchetti, Lisheng Liu, Giuseppe Mancia, Gianfranco Parati, Guido Grassi, Marco Stramba-Badiale, Vincenzo Silani, Grzegorz Bilo, Giovanni Corrao, Antonella Zambon, Lorenza Scotti, Xinhua Zhang, HayYan Wang, Yuqing Zhang, Xuezhong Zhang, Ting Rui Guan, Eivind Berge, Josep Redon, Krzysztof Narkiewicz, Anna Dominiczak, Peter Nilsson, Margus Viigimaa, Stéphane Laurent, Enrico Agabiti-Rosei, Zhaosu Wu, Dingliang Zhu, José Luis Rodicio, Luis Miguel Ruilope, Nieves Martell-Claros, Fernando Pinto, Roland E Schmieder, Michel Burnier, Maciej Banach, Renata Cifkova, Csaba Farsang, Alexandra Konradi, Irina Lazareva, Yuriy Sirenko, Maria Dorobantu, Arman Postadzhiyan, Rok Accetto, Bojan Jelakovic, Dragan Lovic, Athanasios J Manolis, Philippos Stylianou, Serap Erdine, Dror Dicker, Gangzhi Wei, Chengbin Xu, Hengge Xie, Antonio Coca, John O'Brien, Gary Ford
• Journal: Journal of hypertension (J Hypertens) Vol. 32 Issue 9 Pg. 1741-50 (Sep 2014) ISSN: 1473-5598 [Electronic] Netherlands
• PMID: 24979302 (Publication Type: Journal Article, Review)

Chemical References

• Cholesterol, LDL
• Cholesterol

Topics

• Blood Pressure (drug effects)
• Cholesterol
• Cholesterol, LDL (blood)
• Cognition
• Cognition Disorders (prevention & control)
• Humans
• Hypercholesterolemia (drug therapy)
• Male
• Primary Prevention
• Randomized Controlled Trials as Topic
• Recurrence
• Secondary Prevention
• Stroke (prevention & control)