Optimal blood pressure target in stroke prevention.

PURPOSE OF REVIEW: A generalized single blood pressure (BP) goal may appear not suitable to achieve an optimal stroke prevention at the individual level. The aim of the present review is to consider the clinical relevance of individualized BP goal according to patient's age, comorbidities and established cerebrovascular disease.

RECENT FINDINGS: Observational and interventional data support heterogeneity in target organ prevention in that lower BP values than recommended by hypertension guidelines are associated with further stroke risk reduction. However, more ambitious BP treatment targets appear not broadly applicable to ageing hypertensive individuals or patients with established cerebrovascular disease.

SUMMARY: Strict BP control in early diagnosed hypertensive individuals, without established arterial disease, should be a priority in primary stroke prevention. In ageing hypertensive individuals, difficult to control SBP can be considered as a marker of increased systemic arterial disease in the brain, the heart and the kidneys. A delayed aggressive intervention to reduce BP in these high-risk patients may be associated with a J-shaped relationship between BP level and adverse events. Moreover, patients suffering from stroke frequently presented with a high burden of small cerebral vessel lesions that are associated with an increased risk of cognitive decline progression, particularly with stringent BP levels.