Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence.
Zanchetti A., Liu L., Mancia G., Parati G., Grassi G., Stramba-Badiale M., Silani V., Bilo G., Corrao G., Zambon A., Scotti L., Zhang X., Wang H., Zhang Y., Zhang X., Guan TR., Berge E., Redon J., Narkiewicz K., Dominiczak A., Nilsson P., Viigimaa M., Laurent S., Agabiti-Rosei E., Wu Z., Zhu D., Rodicio JL., Ruilope LM., Martell-Claros N., Pinto F., Schmieder RE., Burnier M., Banach M., Cifkova R., Farsang C., Konradi A., Lazareva I., Sirenko Y., Dorobantu M., Postadzhiyan A., Accetto R., Jelakovic B., Lovic D., Manolis AJ., Stylianou P., Erdine S., Dicker D., Wei G., Xu C., Xie H., Coca A., O'Brien J., Ford G.
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.