The discussion presented here is a summary of the debate given at the combined Stroke Society of Australasia and Smart Strokes meeting in 2015. In summary, the evidence for blood pressure lowering at discharge has been extrapolated from clinical trial performed in the latter phase of stroke. Evidence of harm from early commencing blood pressure therapy was provided. The debate ended with emphasis on personalized medicine and proposal for other avenues to improve the use of secondary stroke prevention strategies.
PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358: 1033–1041.
2.
ThriftAGKimJDouzmanianV. Discharge is a critical time to influence 10-year use of secondary prevention therapies for stroke. Stroke2014; 45: 539–544.
3.
AhmedNNasmanPWahlgrenNG. Effect of intravenous nimodipine on blood pressure and outcome after acute stroke. Stroke2000; 31: 1250–1255.
4.
SandsetECMurrayGDBathPMKjeldsenSEBergeE. Relation between change in blood pressure in acute stroke and risk of early adverse events and poor outcome. Stroke2012; 43: 2108–2114.
5.
OhMSYuKHHongKS. Modest blood pressure reduction with valsartan in acute ischemic stroke: a prospective, randomized, open-label, blinded-end-point trial. Int J Stroke2015; 10: 745–751.
6.
OvbiageleBDienerHCYusufS. Level of systolic blood pressure within the normal range and risk of recurrent stroke. JAMA2011; 306: 2137–2144.
7.
RothwellPMHowardSCSpenceJDCarotid Endarterectomy TrialistsC. Relationship between blood pressure and stroke risk in patients with symptomatic carotid occlusive disease. Stroke2003; 34: 2583–2590.
8.
SandersLMSrikanthVKJolleyDJ. Monash transient ischemic attack triaging treatment: safety of a transient ischemic attack mechanism-based outpatient model of care. Stroke2012; 43: 2936–2941.