The role of blood pressure management in stroke prevention: current status and future prospects

ABSTRACT

Introduction

Stroke is the second-leading cause of death worldwide and the second-leading cause of disability-adjusted life-years. It is well known that hypertension is a significant risk factor for cardiovascular events, including stroke.

Areas covered

Recent interventional trials have demonstrated the superiority of intensive blood pressure (BP) control for prevention of cardiovascular events compared to standard BP control. Notably, in the Strategy of Blood Pressure Intervention in Elderly Hypertensive Patients (STEP) trial, intensive BP control showed superiority in the prevention of stroke events in elderly hypertensive patients. Novel medications such as angiotensin receptor-neprilysin inhibitors and sodium glucose cotransporter 2 inhibitors have the potential to suppress various CVD events including stroke. Non-pharmacological antihypertensive therapies such as renal denervation have demonstrated BP-lowering effects and may be useful for stroke prevention. Additionally, new methods and systems of BP monitoring including various kinds of nighttime BP measurement devices, wearable devices, and methods using information and communication technology can be used to assess the pathophysiology of BP variability as a risk factor and an event trigger of stroke incidence.

Expert opinion

Novel therapies and new technologies for BP evaluation strongly support the development of individualized anticipatory medicine, which should be useful for the prevention of stroke.

KEYWORDS:

• Stroke
• blood pressure
• cardiovascular disease
• prevention
• information technology

Article highlights

• Hypertension is a significant risk factor for stroke.

• The usefulness of the management of intensive blood pressure (BP) control for prevention of cardiovascular events including stroke has been established by recent interventional trials.

• Novel medications such as angiotensin receptor-neprilysin inhibitors, sodium glucose cotransporter 2 inhibitors, and selective nonsteroidal mineral corticoid receptor antagonist (esaxerenone and finerenone) have the potential to suppress cardiovascular events including stroke.

• New methods and systems of BP monitoring including various kinds of nighttime BP measurement devices and wearable devices can be used to assess the pathophysiology of BP variability as a risk factor and an event trigger of stroke incidence.

• Digital therapeutics of hypertension: information and communication technology is applied to the management of hypertension, e.g. smartphone application for treatment of hypertension.

• BP variability is a new target of hypertension therapy.

Declaration of Interest

K Kario reports research grants from A&D, Omron Healthcare, Fukuda Denshi, Otsuka Pharmaceutical, Otsuka Holdings, CureApp, Sanwa Kagaku Kenkyusho, Daiichi Sankyo, MSD, Astellas Pharma, Eisai, Taisho Pharmaceutical, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, Mitsubishi Tanabe Pharma, Teijin Pharma, Boehringer Ingelheim Japan, Fukuda Lifetec, Bristol-Myers Squibb, Mochida Pharmaceutical, Roche Diagnostics; Consulting fees from A&D, JIMRO, Omron Healthcare, CureApp, Kyowa Kirin, Sanwa Kagaku Kenkyusho, Terumo, Fukuda Denshi, Mochida Pharmaceutical; Honoraria from Otsuka Pharmaceuticals, Omron Healthcare, Daiichi Sankyo, Novartis Pharma, Mylan EPD; Participation in Advisory Board of Daiichi Sankyo, Novartis Pharma, Fukuda Denshi. Patent, Fukuda Denshi.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.