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Prehypertension Tied to Increased Risk of Stroke

Study: Even Slightly High Blood Pressure Is Associated With Significant Stroke Risk
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Does Higher-Than-Normal Blood Pressure Need Drug Treatment?

Experts who were not involved in the study called its findings compelling and said they may ultimately shift the threshold that doctors use to decide when to put their patients on blood-pressure-lowering drugs.

“It really makes us wonder whether we should be prescribing medications for those individuals,” says Amytis Towfighi, MD, assistant professor of neurology at University of Southern California in Los Angeles and chair of the neurology department at Rancho Los Amigos National Rehabilitation Center in Downey, Calif.

“However, to know for sure, we’d have to do a study to see if prescribing medications will actually lower stroke risk for those individuals,” says Towfighi, who wrote an editorial on the study.

Current guidelines don’t recommend medication for people with slightly elevated blood pressure unless they also have other health conditions like diabetes or chronic kidney disease.

Study researchers say that lifestyle changes are the best place to start when blood pressure numbers creep up into the prehypertension range.

Lifestyle changes that have been shown to lower blood pressure include cutting back on sodium and losing weight. “Lifestyle changes are very, very difficult, but if they’re done properly, we know that they work,” says Ovbiagele. “As a physician, I still think the best way to go is to modify one’s lifestyle.

“We know that prehypertension is rising with the obesity epidemic. I see patients who are 17, 18, and 19 who are having strokes, and they are almost exclusively obese. So I think something is going on and lifestyle changes could have an impact, albeit modest.”

That’s the advice Ovbiagele gives to his patients, but he knows that it may be difficult to make the changes necessary to get their blood pressure down to normal.

So he’s in the midst of designing his next study, which will test whether blood-pressure-lowering medications reduce stroke risk when they’re given to treat adults younger than 65 with blood pressures over 130/85.

One previous, small study did show that medication, when given for blood pressures in the prehypertensive range, were relatively safe and effective at preventing people from going on to develop full-blown high blood pressure (hypertension). The study did not follow patients to see if the aggressive therapy was able to lower a person’s risk for having a heart attack or stroke.

“That’s what we want to do,” says Ovbiagele.

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