Fuentes B, Ortega-Casarrubios M A, Martínez P, Díez-Tejedor E
Stroke Unit, Department of Neurology, University Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
Cerebrovasc Dis. 2007;24 Suppl 1:96-106. doi: 10.1159/000107384. Epub 2007 Nov 1.
Secondary stroke prevention comprises a broad spectrum of therapeutic actions that includes the appropriate management of risk factors and the action on blood pressure and serum lipids that are of great importance to decrease stroke recurrences.
We conducted a review of the published studies analyzing the relevance of the treatment of blood pressure and serum lipids, with special attention to recent findings of clinical trials and current guidelines on stroke secondary prevention.
The relationship between blood pressure and stroke has been widely demonstrated; however, the role of serum lipids has been discussed for a long time. Recent results from epidemiological studies and clinical trials have demonstrated its role as modifiable risk factor for stroke. Blood pressure and lipid lowering are associated with significant reductions in recurrent strokes as well as in other vascular events in transient ischemic attack (TIA) or stroke patients. The PROGRESS and MOSES trials suggest that diuretics, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers could confer additional benefits in stroke patients, and the SPARCL study did so for statins. These drugs are not only efficacious in the reduction of stroke recurrences, but also in other cardiovascular events.
Blood pressure and serum lipids are two important and modifiable vascular risk factors that should be taken into consideration when planning secondary stroke prevention measures. This approach should include hypotensive drugs (mainly the combination of diuretics and ACE inhibitors) with the objective to maintain normal blood pressure, avoiding levels >130/80 mm Hg in all stroke patients, and statins (atorvastatin 80 mg) in patients with noncardioembolic TIA or stroke.
二级卒中预防包括一系列广泛的治疗措施，其中包括对危险因素的适当管理以及对血压和血脂的干预，这对于降低卒中复发至关重要。
我们对已发表的研究进行了综述，分析血压和血脂治疗的相关性，特别关注临床试验的最新发现以及当前卒中二级预防指南。
血压与卒中之间的关系已得到广泛证实；然而，血脂的作用长期以来一直存在争议。流行病学研究和临床试验的最新结果表明，血脂是卒中的一个可改变的危险因素。降低血压和血脂与显著降低复发性卒中以及短暂性脑缺血发作（TIA）或卒中患者的其他血管事件相关。PROGRESS和MOSES试验表明，利尿剂、血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂可能给卒中患者带来额外益处，SPARCL研究则表明他汀类药物有此作用。这些药物不仅在降低卒中复发方面有效，而且在预防其他心血管事件方面也有效。
血压和血脂是两个重要且可改变的血管危险因素，在制定二级卒中预防措施时应予以考虑。这种方法应包括使用降压药物（主要是利尿剂和ACE抑制剂联合使用）以维持正常血压，所有卒中患者均应避免血压水平>130/80 mmHg，对于非心源性TIA或卒中患者应使用他汀类药物（阿托伐他汀80 mg）。
