The management of hypertension for primary stroke prevention: a proposed approach


  • Mukul Sharma,

    1. Regional Stroke Program, Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
    2. Canadian Stroke Network, Ottawa, ON, Canada
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  • Antoine M. Hakim

    Corresponding author
    1. Canadian Stroke Network, Ottawa, ON, Canada
    2. Division of Neurology, University of Ottawa, Ottawa, ON, Canada
    3. Neuroscience Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
    4. The Heart & Stroke Foundation Centre for Stroke Recovery, University of Ottawa, Ottawa, ON, Canada
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  • Conflict of interest: Mukul Sharma: Speakers Bureau for Boehringer Ingelheim (BI), Sanofi/BMS, Merck and Pfizer (modest relationship), and consultant/advisory board for Boehringer Ingelheim (BI), Sanofi/BMS (modest relationship). Antoine Hakim: None declared.

Antoine M. Hakim*, University of Ottawa, 2413–451 Smyth Road, Ottawa, ON, Canada K1H 8M5. E-mail:


The prevalence of hypertension in society is high and increasing. Untreated hypertension results in stroke, dementia, and damage to major organs. This article reviews the risks that hypertension causes and the issues now generally accepted as playing a role in the low level of hypertension control. These include lack of public awareness of the significance of elevated blood pressure, lack of impetus to measure blood pressure, lack of sites to perform the measurements, occasional therapeutic inertia on the part of the medical community, and poor compliance with treatment on the part of affected individuals. Innovative measures that may result in improved management of this risk factor are discussed. These include ubiquitous blood pressure measurement sites, expanding therapeutic potential by involving allied health professionals, and offering rewards for treatment and for compliance. The article also emphasises that the ideal blood pressure target for the primary prevention of stroke remains unclear.