Stroke Risk Associated With Lowering Elevated Blood Pressure in Patients With Transient Ischemic Attack

Background Hypertension is a risk factor for developing stroke after transient ischemic attack (TIA), yet it is unknown if stroke risk is altered by emergency department (ED) antihypertensive therapy. We aimed to investigate stroke rate in a population of TIA patients presenting with elevated blood pressure in the ED, comparing those who received antihypertensive medication in the ED to those who received no treatment. Secondarily, we aimed to assess the association between ED antihypertensive therapy and intensive care unit (ICU) admit rates, hospital length of stay (LOS), and discharge disposition setting in this population. Methods We conducted a retrospective cohort study evaluating adult TIA patients presenting with elevated blood pressure (diastolic ≥ 140 mm Hg or systolic ≥ 90 mm Hg) at any of our Metro Detroit hospital system's EDs between August 2016 and April 2022. We collected data on age, sex, race, blood pressure in the ED, ED antihypertensive therapy, stroke in the subsequent hospital stay, hospital LOS, ICU admission rates, and discharge disposition. Patient characteristics were summarized using descriptive statistics and two-sample hypothesis testing. We assessed the outcomes of antihypertensive treatment using multivariable logistic regression controlling for patient characteristics. Results There were 3,095 patients included in our analysis, of which 21.0% (649) received antihypertensive treatment and 13.9% (429) suffered a stroke. There was no significant difference in stroke rate in the treatment group compared to the no-treatment group (aOR, 1.12 (95% CI, 0.87-1.43)). There was a slightly longer hospital LOS in the treatment group (2.1 days vs 1.9 days), but no differences were seen in ICU admission or discharge disposition. Conclusion In TIA patients presenting with elevated blood pressure in the ED, antihypertensive therapy does not appear to be associated with decreased stroke risk in the subsequent hospital stay.