What is the first-line therapy for patients with hypertension and a history of stroke?

For patients with hypertension and a history of stroke, ACE inhibitors or ARBs are considered first-line therapy based on their effectiveness in reducing cardiovascular events and improving outcomes in this population. These medications not only help to control blood pressure but also have neuroprotective effects that are particularly beneficial for stroke prevention.

ACE inhibitors, such as lisinopril, and angiotensin receptor blockers, like losartan, are shown to decrease the risk of recurrent strokes and have favorable effects on the cardiovascular system. They help to reduce vascular resistance and improve endothelial function, making them a suitable choice for managing hypertension in individuals with cerebrovascular risks.

In contrast, while calcium channel blockers and thiazides may be effective antihypertensives, they do not have the same level of evidence supporting their use specifically for stroke prevention compared to ACE inhibitors and ARBs. Empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor primarily used for diabetes management, is not typically utilized as a first-line treatment for hypertension in patients with a history of stroke.