Guiding Principles in Reducing Stroke Mortality

Using the new, more stringent blood pressure cutoffs for hypertension recommended by 2017 American College of Cardiology (ACC)/American Heart Association (AHA), compared to those recommended by the seventh report of the Joint National Committee (JNC), would result in almost 67% increase in the proportion of stroke survivors with hypertension, and 54% increase in stroke survivors with hypertension not at goal. That means many more stroke survivors with hypertension would be recommended earlier antihypertensive treatment and lifestyle modification. As a result, death from a repeat stroke could decrease by almost 33%.

“The societal gain if the new guidelines were fully implemented would be reflected in the lower stroke recurrence rate, as suggested by prior studies that have found that every reduction of 1 mm Hg of BP was associated with a 4% reduction in stroke recurrence,” wrote first author Alain Lekoubou, MD, MSc, of the Medical University of South Carolina (Charleston, SC), and colleagues. “Our results call for preemptive actions to successfully implement the new guidelines in stroke survivors,” they added.

A large body of evidence has shown that hypertension increases the risk of stroke in a dose response fashion. While hypertension is linked to increased mortality in stroke, research has also shown a decline in stroke mortality over the past several decades, largely due to treatment for hypertension.

• Large analysis of NHANES data suggests using 2017 ACC/AHA cutoffs for hypertension compared to those recommended by JNC7 would result in a substantial increase in the number of stroke survivors with hypertension as well as in those with treated hypertension but not at goal
• Using the 2017 ACC/AHA guidelines would result in an increase in early treatment for hypertension among stroke survivors, and may substantially decrease death from recurrent stroke
• The authors call for action to implement the 2017 ACC/AHA guidelines among stroke survivors.