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High blood pressure (BP) is a well-established risk factor for stroke1 and its subtypes, including lacunar infarction.2 A recent systematic review and meta-analysis of 19 trials involving >40,000 participants indicates substantial benefits of BP-lowering treatment for the prevention of stroke, with the treatment effect consistent across major patient subgroups and different regimens and for even greater benefits derived from more intensive BP lowering.3 Subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) secondary stroke prevention trial also demonstrates broadly beneficial effects of BP lowering on every stroke subtype,4 while the emergence of visit-to-visit BP variability as an important independent predictor of stroke emphasizes the importance of optimal BP control.5 However, and for obvious methodologic reasons, few studies have investigated the importance of BP trajectory or its variability before the onset of stroke or TIA.
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- © 2018 American Academy of Neurology
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