World Stroke Organization and World Hypertension League Position Statement on Hypertension Control Strategies in Prevention and Management of Stroke

Background and Purpose:- The goal of this consensus is to provide a comprehensive set of recommendations regarding hypertension control strategies for the prevention and management of stroke. This document is intended for prehospital care providers, physicians, allied health professionals, and hospital administrators and health care policy makers. Methods:- Members of the writing group were representatives of the World Stroke Organization and World Hypertension League. The writing group reviewed articles searched from PubMed and Google Scholar using selected search strings. The document was sent to 12 peer reviewers. The writing group considered the feedback from peer reviewers and made revisions accordingly. Every member of the writing group gave their approval of the final document. Results:- This article details the various techniques for blood pressure (BP) measurement, BP classification, BP and stroke risk, antihypertensive drug therapy for the primary and secondary prevention of stroke, choice of antihypertensive drug therapy, optimal BP targets, non-drug approaches to the prevention of stroke through BP lowering, BP management separately for acute ischemic stroke and spontaneous intracerebral hemorrhage, and the implementation of BP prevention,treatment and control in the community. Conclusions:- This article provides general recommendations based on currently available evidence to guide healthcare practitioners caring for adults with hypertension to prevent and manage stroke. Future studies are needed to better define approaches to hypertension control in the community and high-risk groups. Abbreviations BP: Blood Pressure, SBP: Systolic Blood Pressure, HIC: High Income Countries, LMIC: Low and Middle Income Countries, CVD: Cardiovascular diseases, WSO: World Stroke Organization, WHL:World Hypertension League, K: Karotkoff, ABPM: Ambulatory BP measurements, HBPM: Home BP Monitoring, CPG: Clinical practice guidelines, ACC: American College of Cardiology, AHA: American Heart Association, DASH: Dietary Approaches to Stop Hypertension, CCB: calcium channel blockers, ACEI: Angiotensin converting enzyme inhibitors, ARB: angiotensin receptor blockers, SPC: single pill combination, ACCORD BP: Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial (ACCORD BP), SPRINT: Systolic Blood Pressure Intervention Trial, RESPECT: Recurrent Stroke Prevention Clinical Outcome Trial , and ESPRIT-:Effects of intensive Systolic blood Pressure lowering treatment in reducing RIsk of vascular evenTs, OPTIMAL-Diabetes: OPtimal Type 2 dIabetes Management, SVIN: Society of Vascular and Interventional Neurology, ICH: intracerebral haemorrhage, NICE-:National Institute for Health and Clinical Excellence