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/viewarticle/443219 Why Do Treated Hypertensives Suffer Strokes? An Internists内科 Perspective Geza Simon, MD J Clin Hypertens 4(5):338-344, 2002. ? 2002 Le Jacq Communications, Inc. Posted 11/22/2002 Abstract and Introduction Abstract Despite widespread treatment of hypertension, stroke continues to be the third leading cause of death in the United States. Antihypertensive therapy is more effective in preventing hemorrhagic出血 strokes than ischemic strokes. In order to understand the reasons why antihypertensive therapy is only partially successful in the Eradication根治 of ischemic局部缺血 strokes, differences in the pathogenesis发病机理 and treatment of subtypes类型 of stroke must be considered. There are three main stroke subtypes of ischemic strokes: small-vessel arteriopathic (lacunar), large-artery atherothrombotic动脉血栓形成, and cardioembolic心脏栓子. Hypertension is the major cause of lacunar strokes but plays a lesser role in the pathogenesis of atherothrombotic strokes. Antihypertensive therapy prevents the majority of lacunar strokes but may not have a major impact on the occurrence of atherothrombotic strokes. Due to impaired消弱 cerebral autoregulation自动调节, overtreatment of hypertension, especially in the elderly and in patients with previous strokes, may paradoxically荒谬地 lead to stroke (J-curve). Assuming that the majority of lacunar strokes are prevented by judicious明智的 antihypertensive therapy, future therapeutic efforts should concentrate on the prevention of atherothrombotic and cardioembolic strokes. In this regard在这点上, refinement 精致of surgical techniques, pharmacologic approaches接近 aimed at plaque stabilization稳定性, and the application of transesophageal食道的 echocardiography超声 for the diagnosis of embolic栓子 strokes (and anticoagulation for a probable source) are promising. Besides the obvious reasons of noncompliance and inadequate therapy, overly aggressive treatment of hypertension in the elderly and stroke mechanisms不顺从 unrelated to blood pressure may explain the occur