RESUMO
Because current therapies for acute stroke are limited, attention must be paid to primary and secondary prevention of stroke. This article focuses on the treatment of chronic hypertension in particular. There is no "one-size-fits-all" treatment, although recent randomized trials have shown that certain agents may be more helpful. Although an exhaustive review would require a textbook, this article reviews some major recent trials and provides evidence-based guidelines for treatment of hypertension for both primary and secondary prevention of stroke.
Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão , Acidente Vascular Cerebral/prevenção & controle , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: There are no data describing a relation between the course of blood pressure and outcome in acute ischemic stroke. We found such a link in a chart review, and then used that data to design a pilot study. We report on the chart review and the first 13 patients enrolled. METHODS: We examined charts of patients admitted to our service in 2000 and stratified them by good (Rankin scale < 4 on discharge, meaning functional independence with a device or better) or poor outcome. A significant difference in blood pressure course and outcome was found, and we then designed a pilot study in an attempt to reproduce these findings. RESULTS: Analysis of the chart review data from 54 patients revealed that the course of mean arterial pressure was different in the two groups: the mean arterial pressure in the group with good outcome decreased about 2 mmHg daily while there was no change in the group with poor outcome (p=0.002 for a difference between slopes). In the pilot trial there were no differences between mean arterial pressure parameters or outcome in either the placebo or treatment groups. Nearly all patients with an admission NIH Stroke Scale score of 6 or less were discharged home. CONCLUSIONS: While our retrospective data were suggestive, we were unable to reproduce findings linking gradual control of blood pressure and outcome in acute ischemic stroke. This pilot study may be used to refine future trials.
