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Antihypertensive Therapy in the Acute Phase of Lacunar Infarcts

Guanghui Zhang1, Pin Meng1, Zhenwei Guo1

  • 1Department of Neurology, The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China (mainland).

Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
|September 23, 2018
PubMed

Insights

Combination antihypertensive therapy, particularly with calcium channel blockers, ACE inhibitors/ARBs, and beta-blockers or diuretics, improves outcomes for acute lacunar infarct patients with hypertension. This approach is superior to single-drug treatments for managing blood pressure and neurological recovery.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Optimal hypertension management during acute lacunar infarcts remains unclear in real-world settings.
  • Lacunar infarcts and hypertension require timely and effective blood pressure control.
  • Understanding the impact of different antihypertensive regimens is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the effects of various blood pressure lowering regimens on neurological progression and clinical outcomes in patients with acute lacunar infarcts.
  • To compare the efficacy of different antihypertensive monotherapies and combination therapies.
  • To identify optimal medical strategies for managing hypertension in the acute phase of lacunar stroke.

Main Methods:

  • A cohort of 411 patients with first-episode lacunar infarcts and hypertension within 24 hours of symptom onset were analyzed.
  • Patients received one of six antihypertensive treatments: calcium channel blockers (CCB), angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), β-blocker (β-B), or diuretic drug (DD), alone or in combination, for the first 7 days.
  • Neurological progression was assessed using the National Institute of Health Stroke Scale (NIHSS), and clinical outcomes were evaluated with the modified Rankin Scale (mRS).

Main Results:

  • Combination therapy including CCB, ACEI/ARB, and β-B showed the lowest risk of neurological deterioration (OR=0.48) and unfavorable outcomes (OR=0.50).
  • Combination therapy with CCB, ACEI/ARB, and DD also demonstrated reduced risk of deterioration (OR=0.63) and unfavorable outcomes (OR=0.77) at 3 months.
  • Logistic regression analysis indicated that combination therapies were associated with significantly better outcomes compared to monotherapy.

Conclusions:

  • Rational blood pressure lowering is beneficial for functional outcomes in the acute phase of lacunar infarcts.
  • Combination antihypertensive therapy is superior to monotherapy in improving clinical outcomes and reducing neurological progression.
  • These findings support the use of specific combination regimens for managing hypertension in acute lacunar stroke.

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