Blood pressure reduction

Introduction to blood pressure lowering medication

  • Medication to lower blood pressure should be considered for secondary prevention after either ischaemic or haemorrhagic stroke
  • At present it is usually started about 2 weeks after an acute stroke
  • Ongoing research aims to establish whether blood pressure lowering should be started immediately after stroke onset.
  • Typically thiazides, e.g. bendroflumethazide and/or ACE inhibitors e.g. Lisinopril, are used after stroke
  • It is useful to have a working knowledge of their common adverse effects so that if these arise they can be attributed to the correct drug
  • A target systolic blood pressure of about 130mmHg is appropriate for most patients, although there are specific exceptions e.g. severe extracranial vascular disease
  • Lifestyle factors, such as reducing salt intake, weight loss, and avoiding excess alcohol also contributes to BP reduction