Treatment of hypertension in acute ischemic stroke

ABSTRACT

There has been substantial controversy regarding treatment of blood pressure in the management of acute ischemic stroke. Non-Uniformity of study design and reporting makes it difficult to draw conclusions from previous data. When to treat hypertension in the acute setting is one of the unsettled questions yet. To study stroke outcome in relation to treatment of hypertension in the management of acute ischemic stroke and its impact on the cardiovascular system. This was a prospective study in which all admitted patients for acute ischemic stroke within 24 hours throughout the year 2006 were included. The severity of the stroke was based on the National Institutes of Health Stroke Scale [NIHSS]. The 2005 AHA/ASA guidelines in the management of acute ischemic stroke were followed. We also followed the same guidelines in the treatment of hypertension in adults with acute ischemic stroke in the first 24 hours. However, patients who continued to have hypertension grade II and III after the first 24 hours were also treated. A total of 356 patients were initially included and managed in the acute phase. Only 241 completed the study and attended the clinics for their follow up assessment at 3 months. The majority were males [76%], preexisting hypertension was found in 68.9% and most of the patients had hypertension on admission [87.5%]. In 223 patients [92.53%] no antihypertensive medication was given in the 1[st] 24 hours. In 134 patients [55.6%] the blood pressure continued to be on the hypertensive side after the first 24 hours and they received antihypertensive medications. The 223 patients [92.53%] who did not receive antihypertensive treatment achieved 57.1%, 78.09% and 73.87% of the total reduction in SBP, DBP and MBP respectively at the end of the 1[st] 24 hours. All cardiac complications [ten patients, 4.15%] were reported in the first 24 hours only. The mean NIHSS score on admission was 22.98 +/- 10.38, while the mean score at the 3[rd] month was 9.4 +/- 6.5. The differences were highly significant [p<0.0001]. When the stepwise regression analysis was used, only the increase in stroke severity at the onset [p<0.0001], followed by the decrease in SBP at the 3[rd] day [p<0.001] and lastly the increase in SBP on admission [p<0.05] were predictive for poor stroke outcome. Introducing antihypertensive medications after the first 24 hours of acute ischemic stroke in patients who continued to have hypertension grade II and III has no negative impact on stroke outcome and limits the cardiovascular complications