What is the role of antihypertensives in the treatment of middle cerebral artery (MCA) stroke?

Updated: Aug 09, 2021
  • Author: Daniel I Slater, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Hypertension is a risk factor for recurrent strokes and is often managed with thiazide diuretics, calcium-channel blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), and angiotensin receptor blockers (ARBs). A number of studies, including the Heart Outcomes Prevention Evaluation (HOPE) study and the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), support the use of ACE inhibitors with or without the combination of a thiazide diuretic to reduce the reduce the risk of stroke recurrence. [82, 83] The Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study supports the use of ARBs to reduce the risk of stroke recurrence. [84]

Beta-blockers are generally considered second-line agents but are often used for rate control. Of note, a meta-analysis has suggested higher mortality with atenolol compared with other antihypertensives when used as initial monotherapy for hypertension. [85]

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