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Blood pressure course in patients with acute stroke and matched controls
Insights
Stroke patients often have high blood pressure (BP) upon admission. While BP naturally declines, those with prior hypertension maintain higher levels, necessitating careful consideration for antihypertensive therapy evaluations.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Research
Background:
- Hypertension is a significant risk factor for stroke.
- Blood pressure management in acute stroke patients remains a complex clinical challenge.
- Existing guidelines suggest cautious antihypertensive therapy for extreme hypertension in stroke, but evidence is limited.
Purpose of the Study:
- To investigate the natural course of blood pressure in patients hospitalized for stroke.
- To compare blood pressure patterns between stroke patients and matched controls.
- To inform the design of future clinical trials evaluating antihypertensive therapy in stroke.
Main Methods:
- Prospective study of 209 consecutive stroke patients and 209 age- and sex-matched controls.
- Monitoring of blood pressure from admission throughout hospitalization.
- Comparison of blood pressure trajectories based on history of hypertension and initial BP levels.
Main Results:
- Stroke patients exhibited higher admission blood pressure (69%) compared to controls (36%), with a higher prevalence of pre-existing hypertension (46% vs 26%).
- A spontaneous decline in blood pressure was observed within the first four days, more pronounced with higher initial values.
- Stroke patients with a history of hypertension consistently showed the highest BP levels during hospitalization, while normotensive controls had the lowest.
Conclusions:
- Blood pressure in stroke patients follows a natural course with a spontaneous decline, influenced by initial levels and history of hypertension.
- The distinct BP patterns observed highlight the need for carefully designed studies, including appropriately matched controls, to evaluate antihypertensive therapies in this population.
- Findings underscore the importance of considering baseline hypertension status when planning interventions for blood pressure management in acute stroke.
Abstract:
The natural course of blood pressure (BP) was studied after emergency hospitalization in 209 consecutive stroke patients and as many age and sex matched controls. Histories of hypertension were more common among patients than controls (46% vs 26%). On admission 69% of the stroke group and 36% of the controls had BP greater than or equal to 170/100 mm Hg. In the first four days there was a spontaneous BP decline, which was greater the higher the initial values. During the whole hospitalization though, stroke patients with previous hypertension had the highest BP levels and previously normotensive controls the lowest. Even if WHO as well as the Joint Committee for Stroke have recommended cautious antihypertensive therapy in stroke patients with extreme hypertension, such therapy is not evaluated. If this is to be done, the present findings have to be taken into consideration. Stroke controls, matched according to the initial BP level, will thus be required.