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Transient ischaemic attacks (TIA) are neurological events caused by temporary cerebrovascular disorders whose effects can be fully reversed within 24 hours. TIAs are forewarnings of an impending stroke. On the average, 15% of the patients suffer a stroke within 90 days after a TIA; half of the strokes occur within the first 48 hours. This necessitates very prompt diagnosis that includes medical examination, determination of risk factors, ultrasound examination of the cerebral vessels, cerebral imaging, ECG and echocardiography. Secondary prevention includes administering platelet inhibitors or, in case of cardiogenic embolism, oral anticoagulants, treatment of vascular risk factors and a change in lifestyle. Surgical or interventional therapy is indicated if severe stenosis of the cerebral arteries is present.

Objective: To compare the effects of combined therapy of an angiotensin II receptor blocker (ARB; valsartan) and an angiotensin converting enzyme inhibitor (ACEI; perindopril) on blood pressure (BP), metabolic profiles, plasma brain natriuretic peptide (BNP) levels, echocardiographic findings, and aortic pulse wave velocity (PWV) with those of respective monotherapy in never-treated patients with essential hypertension., Methods: This was a prospective randomized trial, in which there were 31 patients with essential hypertension and left ventricular hypertrophy (LVH) who visited the outpatient clinic of Oita Red Cross Hospital (14 women and 17 men; mean+/-SD age, 59+/-5 years). Each patient was randomly assigned to receive valsartan (160 mg/day, V group, n=10), perindopril (8 mg/day, P group, n=11), or a combination of valsartan (80 mg/day) and perindopril (4 mg/day, V+P group, n=10) for 40 weeks. Ambulatory BP monitoring (ABPM), echocardiographic findings, metabolic findings, plasma BNP levels, and brachial-ankle PWV (baPWV) were evaluated before and after the 40-week therapy., Results: The baseline and post-therapeutic BP levels were similar among the three groups. At baseline ABPM, non-dipping was observed in 80, 82, and 80% in the V, P, and V+P groups, respectively. Each 40-week therapy regimen comparably reduced ABP. The plasma BNP levels (P<0.0001 for each), left ventricular mass index (LVMI) (P<0.01 for each), and PWV values (P<0.0001 for each) were also reduced. However, when compared with either V or P group, the percentage reduction in LVMI (P<0.05 and P<0.005, respectively), BNP (P<0.05 for each), and baPWV values (P<0.005 and P<0.001, respectively) was greater in the V+P group., Conclusions: Our findings suggest that, when compared with each monotherapy, perindopril and valsartan combination therapy exerts greater beneficial effects regarding the regression of LVH, reduction in BNP, and improvement of PWV in a selected group of essential hypertensive patients with LVH and high prevalence of non-dipping patterns.

Some of the reported findings of numerous studies on the treatment of hypertension are still giving rise to heated discussions. The result is conflicting recommendations and uncertainty among care-providing physicians. Today, the substances from the group of more recent hypertensive agents (calcium antagonists, ACE-inhibitors and angiotensin 1 receptor blockers) together with the classical agents (diuretics and beta blockers) are recognized as equally justifiable as the five agents of first choice in the treatment of uncomplicated hypertension. If, however, accompanying diseases are present, the choice of primary medication depends on the respective risk (diabetes, etc.) of the individual patient. In many cases, combination treatment should be considered from the very beginning.