H.B. van der Worp
- In patients who have recently had a TIA or stroke, the risk of new serious cardiovascular disease is decreased by the pharmacological reduction of the serum cholesterol level and blood pressure; this has been convincingly demonstrated by randomised clinical trials.
- There is sufficient evidence that cholesterol-lowering treatment is effective in patients with a TIA or cerebral infarction who have a total cholesterol ≥ 3.5 mmol/l. The results from a trial in patients with only a TIA or a minor stroke will have to answer the question whether cholesterol-lowering treatment will be effective in patients > 80 years, and whether higher dosages of simvastatin will be more effective in these patients.
- Antihypertensive therapy is effective in preventing recurrent stroke and myocardial infarction in patients with a recent stroke or TIA.
- It is obvious that the treatment should be started with a diuretic and that a second agent should be added if necessary.
- On epidemiological grounds, vigorous treatment is also justified in patients with a normal or mildly elevated blood pressure; caution and a custom-tailored approach are essential, however, in each individual patient.
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