Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
Hypertension, while usually easily handled, can in certain patients present difficult problems in management. A history of stroke sometimes creates doubt as to the advisability of lowering the blood pressure as this might reduce flow to the brain, causing the patient to have another stroke. It is recognized that severe hypertensives clearly do better if they are treated, but the mild-to-moderate hypertensive patient with a history of stoke is a more difficult problem, and uncertainty about proper management has been so great that a large multicenter clinical trial – randomized, double-blind, and placebo-controlled – of 452 patients was done by the Stroke-Hypertensive Study group, and its results reported in 1974. All 452 patients had a history of a previous stroke and all had mild-to-moderate diastolic hypertension. This study showed that long-term outpatient treatment of the blood pressure neither caused nor prevented a second stroke. Other benefits such as a reduction in the number of episodes of congestive heart failure were evident in the treated group. It would seem, then, that patients with a history of stroke should be treated for their diastolic hypertension, unless there are other contraindications.
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