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Rodríguez-Yañez M, Gómez-Choco M, López-Cancio E, Amaro S, Alonso de Leciñana M, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, García-Pastor A, Gomis M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Roquer J, Segura T, Serena J, Vivancos-Mora J, Fuentes B. Stroke prevention in patients with arterial hypertension: Recommendations of the Spanish Society of Neurology's Stroke Study Group. Neurologia (Engl Ed) 2021; 36:462-471. [PMID: 34238528 DOI: 10.1016/j.nrleng.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. DEVELOPMENT We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. CONCLUSIONS In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels > 140/90 mmHg, with a target BP of < 130/80 mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24 hours), with a target BP of < 130/80 mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable.
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Affiliation(s)
- M Rodríguez-Yañez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari; Departamento de Medicina, Universidad de Barcelona. Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Departamento de Medicina, Universidad Autónoma de Madrid, Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, Spain
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, Spain
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, Spain
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - J Roquer
- Servicio de Neurología, Hospital del Mar, Barcelona, Spain
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Departamento de Medicina, Universidad Autónoma de Madrid, Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, Spain
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Rodríguez-Yañez M, Gómez-Choco M, López-Cancio E, Amaro S, Alonso de Leciñana M, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, García-Pastor A, Gomis M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Roquer J, Segura T, Serena J, Vivancos-Mora J, Fuentes B. Stroke prevention in patients with arterial hypertension: Recommendations of the Spanish Society of Neurology's Stroke Study Group. Neurologia 2020. [PMID: 32893074 DOI: 10.1016/j.nrl.2020.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. DEVELOPMENT We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. CONCLUSIONS In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels >140/90mmHg, with a target BP of <130/80mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24hours), with a target BP of <130/80mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable.
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Affiliation(s)
- M Rodríguez-Yañez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España.
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España.
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari; Departamento de Medicina, Universidad de Barcelona. Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz; Departamento de Medicina, Universidad Autónoma de Madrid. Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, España
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña; Instituto de Investigación Biomédica A Coruña, A Coruña, España
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario Cruces. Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, España
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón; Universidad Complutense de Madrid, Madrid, España
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca; Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, España
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - J Roquer
- Servicio de Neurología, Hospital del Mar, Barcelona, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J Serena
- Servicio de Neurología; Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz; Departamento de Medicina, Universidad Autónoma de Madrid. Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, España
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Mena-Villalba AÁ, Lendínez-de la Cruz JM, Cubero-Gómez CM, Monsalvo-Moro M, Gutiérrez-Ruíz RC, García-Alfonsín A. [Relationship between antihypertensive drug use and development of atrial fibrillation in hypertensive patients in a Primary Care center]. Semergen 2014; 40:247-53. [PMID: 24485970 DOI: 10.1016/j.semerg.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/05/2013] [Accepted: 10/07/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Although antihypertensive treatment can reduce the risk of cardiovascular morbimortality, studies aimed at evaluating the association between antihypertensive drug use and incidence of atrial fibrillation (AF) yield mixed results. This study aimed to determine the possible relationship between antihypertensive drug use and development of AF. MATERIAL AND METHODS Case control study. CASES Hypertensive patients with AF diagnosed at least one year after the start of drug treatment for hypertension. CONTROLS Hypertensive patients without AF with pharmacological antihypertensive treatment for at least one year, matching by sex, age and duration of antihypertensive therapy at diagnosis of AF cases. The study included 136 cases and 132 controls. VARIABLES AF, antihypertensive drugs, control of hypertension, duration of treatment with antihypertensive drugs, number of antihypertensive drugs. ANALYSIS Crude OR were calculated, with logistic regression being used to calculate the adjusted odds ratios. RESULTS Overall, diuretics was close to statistical significance: OR 0.616 (95% CI 0.365 to 1.040), as a protective factor for development of AF. Calcium channel blockers behaved as a protective factor against development of AF at 75 years or older (OR 0.366; 95% CI 0.173 to 0.772), and within this age in women (OR 0.343; 95% CI 0.145-0.811). CONCLUSIONS Calcium channel blockers in the group of 75 years or more, especially in women, worked statistically significant as a drug protecting against the appearance of AF. Diuretics may have a protective role in AF incidence in all hypertensive patients.
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Affiliation(s)
- A Á Mena-Villalba
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
| | - J M Lendínez-de la Cruz
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España.
| | - C M Cubero-Gómez
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
| | - M Monsalvo-Moro
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
| | - R C Gutiérrez-Ruíz
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
| | - A García-Alfonsín
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
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