Stroke, the third most-common cause of mortality after cancer and heart
disease in developed countries, is one of the most common causes of cognitive
impairment and vascular dementia. Stroke pathogenesis and its consequences are not
completely elucidated, with various factors and biological mechanisms probably having
a role. After age, hypertension is the leading modifiable cardiovascular risk factor for
ischaemic/haemorrhagic stroke, small vessel disease predisposing to lacunar infarction,
cerebral white matter lesions (cWML), and cerebral microbleeds. Primary stroke
prevention, involving hypertension therapy and blood pressure (BP) control is now
standard. At the same time, elevated post-stroke BP levels increase the risk of recurrent
stroke, with recent trials suggesting that BP reduction with combinations of
hypertension therapy reduces stroke recurrence. This chapter reviews the evidence on
hypertension as a stroke risk factor and the part played by hypertension therapy in
first/recurrent stroke prevention.
Keywords: Cerebral microbleeds, Cerebral small vessel disease, Cognitive
impairment, Hemorrhagic stroke, Hypertension, Hypertension therapy, Ischemic
stroke, Lacunar infarction, Recurrent stroke, Vascular dementia, White matter
lesions.
