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Overuse of antihypertensives in patients with acute ischemic stroke

Matthew Underwood1, Bob L Lobo, Christopher Finch

  • 1Department of Pharmacy, Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA.

Southern Medical Journal
|January 2, 2007
PubMed

Insights

Aggressive blood pressure management in acute ischemic stroke (AIS) did not worsen outcomes, despite frequent hypotension. Adherence to American Heart Association/American Stroke Association guidelines for hypertension (HTN) in AIS was poor.

Area of Science:

  • Neurology
  • Cardiology
  • Internal Medicine

Background:

  • The American Heart Association/American Stroke Association (AHA/ASA) recommends conservative hypertension (HTN) management during acute ischemic stroke (AIS).
  • Clinicians frequently employ more aggressive blood pressure management strategies in AIS patients.
  • This study investigated the association between aggressive HTN management and hypotensive events or worsened neurologic outcomes in AIS.

Purpose of the Study:

  • To evaluate the impact of aggressive hypertension management on hypotensive events and neurologic outcomes in patients with acute ischemic stroke.
  • To assess adherence to AHA/ASA guidelines for HTN management in the context of AIS.

Main Methods:

  • A retrospective observational cohort study of patients admitted with AIS.
  • Neurologic outcomes were assessed by nurses and verified by physician notes.
  • Management of arterial HTN was systematically recorded for all patients.

Main Results:

  • Despite only 22% meeting AHA/ASA criteria, 98% of AIS patients received antihypertensive therapy.
  • Relative hypotension occurred in 64% of treated patients.
  • Absolute hypotension and excessive blood pressure reduction were not significantly associated with worsened neurologic outcomes.

Conclusions:

  • Adherence to AHA/ASA guidelines for HTN management in AIS is suboptimal.
  • Initiating or intensifying antihypertensive therapy was not linked to adverse neurologic outcomes.
  • Hypotensive events and excessive blood pressure reduction did not correlate with worsened neurologic outcomes in AIS.
Abstract

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