Research published in JAMA Neurology suggests maintaining a blood pressure of 130/80 mm Hg or less to reduce the stroke recurrence risk. The study was led by Dr. Kazuo Kitagawa, who is a professor and chair of neurology at Tokyo Women’s Medical University in Japan.
The study included nearly 1,300 stoke survivors that were volunteers recruited from 140 hospitals in Japan. They were enrolled between 2010 and 2016. All participants were randomly assigned to one of two groups, an intensive control group that aimed for a blood pressure reading of 120/80 or lower, and a standard control group of 140/90 blood pressure.
The starting baseline for both groups was 145/84 mm Hg. During the follow-up period, the standard group’s blood pressure experienced an average drop of 133/78, and the intensive group was reduced to an average of 127/77.
During the study period, 91 people suffered a second stroke. However, the intensive group did appear to have a lower risk of recurring stroke. The authors of the study did note that the findings were not statistically significant, but when pooled with the results of previous studies on blood pressure reduction, it was confirmed that there was a drop in risk of 22 percent for intensive control.
When speaking about the study, Kitagawa noted that 120/80 mm Hg or lower might be an even better target, but only about one-third of people in the current study were able to achieve a level that low, despite being on an average of almost three blood pressure-lowering drugs. Kitagawa believes that patients are wary of lowering their blood pressure too much as there are side effects that can be associated with aggressive blood pressure reduction.
Lower Blood Pressure is Straightforward
An editorial accompanying the study written by Dr. Craig Anderson said that lowering blood pressure “is relatively straightforward.” But to effectively control blood pressure, doctors often need to prescribe multiple medications, though not all doctors will do so.
Anderson, a professor of neurology at the University of New South Wales in Sydney, Australia went on to note, “Perhaps doctors have a tendency to be conservative in their use of antihypertensive medications, particularly in older, frailer people, because of the genuine concern about causing side effects, such as a fall from dizziness leading to a hip fracture.”
Some of the most common side effects of blood pressure-lowering drugs are mild, such as dizziness, inflammation in the ankles, and fatigue. But often, these can be avoided by modifying the drug dosage. Less common side effects can include falls, fainting, and impaired kidney function.
Although doctors may be hesitant to prescribe antihypertensive medications because of these side effects, there are also many benefits associated with these drugs. Anderson said that while doctors don’t know precisely how lower blood pressure reduces the risk of stroke, “presumably, it reduces stress on the walls of blood vessels, which lessens the chance of thickening and blockage and rupturing of them.”
One point that both Kitagawa and Anderson both agree on is that making lifestyle changes can go a long way to controlling blood pressure. Maintaining a healthy weight, eating healthy foods, exercising regularly, reducing stress, and reducing salt intake all play an important role in reducing the risk of a second stroke.