ABSTRACT
The importance of high blood pressure (BP) in acute stroke has been recognised for some time. As early as the 18th century physicians were attempting management of the condition through large volume venesection (1). The role of hypertension in the etiology of cerebrovascular disease is now well established from actuarial data and prospective epidemiology (2,3). There is a log-linear relationship between increasing arterial pressure and first ever stroke (4), a similar relationship appears to hold for recurrent stroke (5). A rise of mean BP of 10 mmHg leads to a 30% increase in ischaemic stroke risk (6). The corresponding risk of intracerebral haemorrhage is greater still (7). More recently large scale randomised controlled trials have confirmed the importance of reducing BP in primary and secondary prevention of stroke and other cardiovascular diseases (8). There is now overwhelming evidence that regardless of class of agent used, relative BP reduction has a significant early and long-term effect on reducing stroke risk (9). Newer antihypertensive agents may have important class specific beneficial effects in stroke prevention in addition to their BP reducing actions (8).
