Background
In Germany, stroke remains the second most common cause of death after coronary heart disease and is the leading cause of disability in adults. Due to the demographic trends, it is expected that the prevalence will continue to increase, which is associated with increasing health care costs.
Discussion
A—modifiable—risk factor for stroke is arterial hypertension. Thus, consequent high blood pressure treatment is the most important and effective tool for both primary and secondary prevention of stroke. It has also been demonstrated that hypertension has an influence on vascular and Alzheimer’s dementia. Because diabetes mellitus is associated with chronic cerebral damage and also a significantly increased risk of stroke, the control of hypertension in diabetes patients is particularly important.
Perspectives
No consensus or controversies exist for the target blood pressure ranges/target windows in various constellations, for the selection and combination of antihypertensive agents, for a possible J/U relationship between blood pressure and cerebro-/cardiovascular events as well as the limit values for the initiation of drug therapy in patients with/without diabetes. Since 2013, the multicenter, randomized ESH/CHL-SHOT trial has been examining how a greater reduction in blood pressure (<135 to 125 or even <125 mmHg) affects the recurrence of stroke, cardiovascular outcome, and cognitive decline in older patients. Results are expected in November 2018.