Lowering sbp 10-12 points and DBP 5-6 points leads to 38 % fewer strokes . PROGRESS trial of ACEi v indapamide v. plac showed 9/4 bp reduction led to 28 % fewer strokes. HOPE randomized 9297 patients to ramipril or placebo, leading to 3/2 bp reduction and 32 % less strokes. LIFE (losartan ) trial showed 25 % reduction in stroke without change in blood pressure with ang II blocker. ALLHAT showed more strokes in patients getting lisinopril v. thiazide . Rec is for ACEi + diuretic to get bp < 140/90, or less than 130/80 in diabetics.
Or each 20/10 increase in BP over 115 to 185 doubles risk of stroke
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