Antihypertensive drugs and prevention of atherosclerotic stroke.

THE DRAMATIC DECLINE IN STROKE incidence in North America (approximately 60% in the past 15 years) has provoked much debate about the reasons for the decline. The role of the treatment of blood pressure in the reduction of stroke in general, and intracerebral hemorrhage in particular, has been a focus of the debate. Our recent experience highlights the need to pay attention, in future, to those effects of antihypertensive drugs which may affect atherosclerosis, and supports the hypothesis, put forward in 1975 by Russell, that the strokes prevented by treatment of hypertension are hemorrhagic and lacunar strokes, but not those due to atherosclerosis.