That compared with just over 8 percent of stroke survivors who kept their blood pressure below 140/90.
Those figures do not, however, prove that switching all stroke patients to the ACC/AHA guidelines will prevent that number of deaths, Nissen stressed.
The guideline change was largely driven by a clinical trial called SPRINT. That trial showed that tighter blood pressure control was better for people with additional risk factors for heart disease and stroke — such as clogged heart arteries or kidney disease. Those who aimed for more aggressive control of their systolic blood pressure — instead of the standard 140 or lower — were less likely to die over the next few years.
The trial did not show a reduction in strokes, specifically, Lekoubou said. But, he added, the study did not involve stroke survivors.
Other trials, Lekoubou said, have shown that tighter blood pressure control can reduce the risk of recurrent stroke. Overall, he noted, the evidence suggests that for every point patients shave from their blood pressure numbers, the risk of repeat stroke dips by 4 percent.
Still, lowering blood pressure with medication can come with pitfalls — particularly for elderly, frailer patients, Nissen pointed out. “Certainly, very aggressive blood pressure lowering can carry some risk of dizziness and falls,” he said.
“On the other hand,” Nissen added, “we want to prevent a stroke recurrence.”
The bottom line, Nissen said, is there’s no one-size-fits-all treatment, and stroke survivors should bring any questions to their doctor.
“If their blood pressure is not already at the lower recommended target, they should sit down and have a discussion with their doctor,” he said.
And medication is not the only way to get better numbers, Lekoubou stressed.
Lifestyle changes are just as important,” he said. “With healthy lifestyle choices, you might need less medication to get your blood pressure down.”
Nissen agreed that regular exercise and a healthy diet are key. As an example, he pointed to the DASH (Dietary Approaches to Stop Hypertension) eating plan. It’s rich in foods like fruits, vegetables, fiber-rich grains and low-fat dairy, and low in sodium, sugar and saturated fat.