What is the key to stroke prevention?

    Sustained increases in blood pressure are an important cause in the development of cardiovascular disease. Studies have shown that for every 5 mmHg increase in systolic blood pressure, the risk of stroke increases by 46% and the incidence of myocardial infarction increases by 14%. Therefore, the adverse effects of long-term increase in blood pressure on the cardiovascular and cerebrovascular, has greatly damaged the health of hypertensive patients. At present, international and domestic advocate reasonable combination of antihypertensive treatment, in order to make the blood pressure better achieve the standard. The benefits of blood pressure lowering are reflected in the protection of target organs and the reduction of cardiovascular and cerebrovascular event rates.  In a predominantly middle-aged population, a long-term reduction in diastolic blood pressure of 5 mmHg can reduce the risk of stroke by 35-40%. the HOT study showed that a reduction in diastolic blood pressure to 83 mmHg can reduce cardiovascular risk by 31%, and as age increases, the level of systolic blood pressure is positively associated with both cerebral hemorrhage and cerebral infarction.  Organ damage is associated with different types of blood pressure in hypertensive patients. Office blood pressure has long been used clinically as a criterion for diagnosing blood pressure levels; however, simply measuring office blood pressure does not identify some specific types of hypertension. For example, 1, hidden hypertension: office blood pressure 140/90mmHg, ambulatory blood pressure > 135/85mmHg; 2, “white coat” hypertension: office blood pressure ≥ 140/90mmHg, ambulatory blood pressure 135/85mmHg; 3, non-ladybole hypertension patients: nighttime blood pressure drop of less than daytime blood pressure 5%; 4, patients with increased blood pressure in the early morning. Therefore, a combination of office and ambulatory blood pressure measurement should be used clinically to avoid missing the diagnosis of high-risk hypertensive patients. 24-hour ambulatory blood pressure monitoring is more conducive to the timely and targeted selection of appropriate drug therapy. A number of studies have shown that increased blood pressure at night is more likely to be associated with left ventricular hypertrophy, and elevated blood pressure in the early morning is more likely to result in myocardial ischemia, myocardial infarction, and stroke.  The World Health Organization (WHO)/International Society of Hypertension (ISH) guidelines for the treatment of hypertension state that a 10 mmHg decrease in systolic blood pressure and a 5 mmHg decrease in diastolic blood pressure can reduce the absolute risk of cardiovascular events by 10% over 10 years in very high-risk hypertensive patients.  A meta-analysis of studies of hypertension in older adults found that a 12-14 mmHg reduction in systolic blood pressure and a 5-6 mmHg reduction in diastolic blood pressure resulted in a 34% reduction in the risk of stroke. In another study using nifedipine controlled-release tablets 30-60 mg/d for 4 years for hypertension, patients’ blood pressure decreased from 177/99 mmHg before treatment to 138/82 mmHg after 4 years, with a 50% reduction in the incidence of cardiovascular events.