Antihypertensive therapy and orthostatic hemodynamic responses in acute stroke

It is not known whether antihypertensive medications affect orthostatic blood pressure (BP) regulation in the early period after stroke. Knowledge of this may have implications for clinical practice.

A total of 40 acute ischemic stroke patients (mild-to-moderate severity) taking antihypertensive drugs, and 40 patients with acute stroke of similar severity not receiving such drugs were studied. Blood pressure and heart rate were measured while supine, and then for 5 min while sitting up and for 5 min in the standing posture. This was performed < or =3 days poststroke (day 1) and 1 week after the first study (week 1).

In both groups of patients on day 1 and week 1, there was no significant fall in mean arterial pressure and heart rate after sitting up and standing up. Logistic regression analysis showed that only cardiac dysfunction was associated with orthostatic hypotension on univariate analysis (odds ratio 4.0, P = .02) and multivariate analysis when age, hypertension, stroke severity, and treatment were included (odds ratio 3.5, P = .05). Use of antihypertensive therapy was not associated with orthostatic hypotension on univariate or multivariate analysis.

Use of antihypertensive drugs in the early period poststroke is not detrimental to postural BP regulation. Antihypertensive therapy may therefore be used when indicated in acute stroke, without having to restrict early mobilization; but the results cannot be extrapolated to the postacute phase.