Protection against stroke and dementia: an update on the latest clinical trial evidence.

Recent meta-analyses have examined the relationship between lowering blood pressure (BP) and reducing the risk for stroke and dementia. Studies have shown that drug therapy that successfully reduces systolic BP by only 10 mm Hg results in significant protection against stroke. Controversy exists regarding the most effective regimen, with supporters for the standards of diuretics and beta-blockers, or angiotensin-converting enzyme inhibitors and calcium-channel blockers, pitted against the increasing evidence of the effectiveness of angiotensin-receptor blockers or statins. Additionally, the most effective strategy for delivery of BP-reducing therapy is being examined, with some studies supporting use of standards for primary prevention of stroke and reserving the newer drugs for secondary prevention. Ultimately, however, all agree that for patients with the highest risk for cardiovascular and cerebrovascular complications, the strategy of intervention is immaterial, and drug therapy, including low-dose aspirin, is vital.