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Use of antihypertensive agents in the management of patients with acute ischemic stroke

From the Division of Healthcare Quality (Drs. Lindenauer, Pekow, and Benjamin, J. Fitzgerald), Baystate Medical Center, Springfield, and Department of Medicine (Drs. Lindenauer and Benjamin), Tufts University School of Medicine, Medford, and Department of Biostatistics and Epidemiology (Drs. Mathew and Pekow, T.S. Ntuli), University of Massachusetts Amherst.

Address correspondence and reprint requests to Dr. P.K. Lindenauer, Division of Healthcare Quality, Baystate Medical Center, 759 Chestnut St., P-5931, Springfield, MA 01199; e-mail: Peter.Lindenauer{at}bhs.org

Background: To protect the ischemic penumbra, guidelines have recommended against treating all but the severest elevations in blood pressure during acute ischemic stroke.

Objective: To determine how often antihypertensive agents were used in routine clinical practice and whether this use was consistent with guideline recommendations.

Methods: The records of patients discharged with ischemic stroke in 2000 at Baystate Medical Center in Springfield, MA, were reviewed. Adherence was evaluated by examining the use of antihypertensive agents in the context of daily blood pressure recordings during the first 4 days of hospitalization. Therapy was considered appropriate in the setting of severe hypertension (systolic blood pressure of >220 mm Hg or mean arterial blood pressure of >130 mm Hg) and potentially harmful in the setting of relative (systolic blood pressure of <120 mm Hg or mean arterial blood pressure of <85 mm Hg) or absolute (systolic blood pressure of <90 mm Hg or mean arterial blood pressure of <60 mm Hg) hypotension.

Results: One hundred (65%) of the 154 ischemic stroke patients were treated with antihypertensive agents. Forty-two percent of those who had received therapy prior to admission had their regimen intensified, and 36% of previously untreated patients had therapy initiated. Sixteen (11%) patients had hypertension severe enough to warrant treatment upon arrival, and 34 (22%) had at least one episode of severe hypertension during the first 4 hospital days. Sixty-five (65%) patients developed relative hypotension on a day when antihypertensive agents were administered, and five (5%) developed absolute hypotension.

Conclusions: Most patients with acute ischemic stroke are treated with antihypertensive agents despite the absence of severe hypertension. Although low blood pressure is common among treated patients, frank hypotension is unusual.

Received September 6, 2003. Accepted in final form March 22, 2004.

Presented at the annual meeting of the Society of Hospital Medicine, April 1, 2003, San Diego, CA.

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				T. J. Ingall, P.K. Lindenauer, M.C. Mathew, T.S. Ntuli, P.S. Pekow, J. Fitzgerald, and E.M. Benjamin Use of antihypertensive agents in the management of patients with acute ischemic stroke Neurology, January 25, 2005; 64(2): 401 - 402. [Full Text] [PDF]

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