Choosing the ideal drug for hypertension after ischemic stroke.

Controlling hypertension is known to be the most important treatment in preventing stroke. The past decade has been spent in debate over which class of hypertensive medication is most effective. This article reviews the studies assessing the efficacy of each agent class in secondary stroke prevention. The comparison of studies and agents is often difficult because of differences in achieved blood pressures and in the exact agents and combinations of agents that are used. Meta-analysis has attempted to resolve some of these difficulties by using meta-regression modeling to predict "expected" risk reduction given an achieved blood pressure. The resultant ability to give a value to "blood pressure-independent" effects is questioned. The effect of reducing blood pressure far outweighs any other effect in reducing stroke risk, and the agent that has been shown to be most consistently equal or superior to any agent compared with it has been amlodipine, a calcium-channel blocker.