Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
There is no doubt that treatment of hypertension has a significant role in the prevention of stroke. Recently published data from large, randomized clinical trials show that lowering of blood pressure is associated with a significant decrease in the risk of stroke. Reduction in the risk of stroke varies from approximately one quarter to approximately one third, depending on the study. Furthermore, besides blood pressure lowering it seems that the use of angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers and calcium antagonists could provide some additional beneficial effects. ACE inhibitors and angiotensin receptor blockers could improve endothelial function, cardiac and vascular remodeling, thus retarding the progression of atherosclerosis. Calcium antagonists, especially the highly lipophilic ones, may have some antioxidant properties. They reduce the oxidation of low-density lipoprotein (LDL) cholesterol and its influx into the arterial wall. Amlodipine, lacidipine or nifedipine suppress platelet production in hypertensive patients. Therefore, ACE inhibitors, angiotensin receptor blockers and calcium antagonists could be potential antiatherosclerotic agents. Considering all these data, it could be assumed that a wider use of these drug classes could significantly improve our ability to prevent all vascular diseases, stroke in particular. Data from recently published large randomized clinical trials shed bright light on stroke prevention in the forthcoming future.Liječenje hipertenzije nesumnjivo ima značajnu ulogu u prevenciji moždanog udara. Podaci iz nedavno objavljenih velikih randomiziranih kliničkih studija pokazuju da je snižavanje krvnog tlaka povezano sa značajnim smanjenjem rizika nastanka moždanog udara. Smanjenje rizika nastanka moždanog udara kreće se od jedne trećine do jedne četvrtine, ovisno o studiji. Nadalje, izgleda da bi primjena inhibitora ACE, blokatora angiotenzinskih receptora i kalcijevih antagonista uza snižavanje krvnog tlaka mogla imati i neke dodatne povoljne učinke. Inhibitori ACE i blokatori angiotenzinskih receptora mogli bi poboljšavati funkciju endotela i kardiovaskularno preoblikovanje, te na taj način usporavati proces ateroskleroze. Kalcijevi antagonisti, a naročito visoko lipofilni, mogli bi imati antioksidativna svojstva. Oni smanjuju oksidaciju LDL kolesterola i ulazak LDL kolesterola u arterijsku stjenku. Amlodipin, lacidipin i nifedipin suzbijaju funkcije trombocita kod hipertenzivnih bolesnika. Stoga bi inhibitori ACE, blokatori angiotenzinskih receptora i kalcijevi antagonisti mogli biti i potencijalni antiaterosklerotski lijekovi. Uzimajući u obzir sve podatke moglo bi se pretpostaviti da bi ove skupine lijekova mogle značajno unaprijediti mogućnost prevencije krvožilnih bolesti, a pogotovo moždanog udara. Podaci iz nedavno objavljenih velikih randomiziranih kliničkih studija bacaju novu svjetlost na prevenciju moždanog udara u skoroj budućnosti
