September 6, 2005

Blood pressure lowering helpful after stroke

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - After people suffer a stroke,
lowering their blood pressure can slow or even stop the
progression of lesions in the brain, new research suggests. The
areas of damage are called white matter hyperintensities, or
WMHs, because they show up brightly on MRI, and they have been
linked to the development of dementia and depression.

"Several studies have linked WMHs with hypertension, but it
was unknown if blood pressure lowering could slow the
progression of these lesions," Dr. Christophe Tzourio, from
Hopital La Salpetriere in Paris, told Reuters Health.

Tzourio and his colleague evaluated 192 subjects with
stroke who were enrolled in a trial that examined the benefits
of blood pressure-lowering to prevent repeat strokes. As part
of the study, the subjects were given an ACE-inhibitor alone or
in combination with a diuretic, or an inactive placebo.

MRI was performed at the beginning of the study and at
about 36 months, to assess and grade WMHs, according to the
report in the American Heart Association's journal Circulation.

At follow-up, subjects treated with active agents had a
significant drop in blood pressure compared with those given
placebo. Treatment with antihypertensive agents cut the risk of
new WMHs by 43 percent and was associated with a drop in WMH
volume, the team found.

"Although we've not demonstrated that blood
pressure-lowering stops dementia in these patients, it seems
logical that if it slows the progression of WMHs, it would also
help prevent dementia," Tzourio noted.

Circulation 2005.