Optimising blood pressure control after stroke: established wisdom and new frontiers.

Abstract

High blood pressure is the main modifiable risk factor for preventing cardiovascular events in people who have had a stroke or transient ischaemic attack; however, only approximately one in three people who have had a stroke have adequate blood pressure control, which highlights the need for a change to conventional models of care. New priorities include the broader adoption of combination antihypertensive therapy to maintain systolic blood pressure below 130 mm Hg, with an emphasis on simplified regimens and single pill combinations. Integrated multidisciplinary models of care, coupled with scalable community-based strategies, are essential to overcome therapeutic inertia and fragmentation. Digital health technologies, remote monitoring, potassium-enriched low-sodium salt substitutes, and novel pharmacological agents offer other opportunities to improve preventative care. Effective blood pressure control is a collective imperative to reduce the global burden of stroke and improve long-term outcomes in people with cerebrovascular disease.